Healthcare Provider Details

I. General information

NPI: 1477416204
Provider Name (Legal Business Name): SOUL CATERING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 RENNER AVE
NEWARK NJ
07112-2522
US

IV. Provider business mailing address

31 E 2ND ST
BAYONNE NJ
07002-3403
US

V. Phone/Fax

Practice location:
  • Phone: 973-417-2614
  • Fax:
Mailing address:
  • Phone: 973-417-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA FUNN
Title or Position: CEO
Credential:
Phone: 973-417-2614