Healthcare Provider Details

I. General information

NPI: 1487249876
Provider Name (Legal Business Name): YOUR FOOD NUTRITION COACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RIDGEWOOD AVE STE 415
PARAMUS NJ
07652-3915
US

IV. Provider business mailing address

688 SEAGULL DRIVE
PARAMUS NJ
07652-4944
US

V. Phone/Fax

Practice location:
  • Phone: 201-720-1900
  • Fax: 201-367-3779
Mailing address:
  • Phone: 201-960-9636
  • Fax: 201-881-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANA MARIE RODRIGUEZ
Title or Position: OWNER
Credential: RDN
Phone: 201-614-1900