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General NPI Number Information
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NPI Number | 1174998660
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Entity Type | Organization
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Legal Business Name | SAGE NUTRITION AND HEALING CENTER CORPORATION
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 242 STATE ROUTE 79 N STE 8
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City | MORGANVILLE
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State | NJ
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Zip | 07751-2079
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Country | US
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Telephone | 732-443-0300
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Fax | 732-526-4150
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Provider Business Mailing Address
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Address Line | 242 STATE ROUTE 79 N STE 8
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City | MORGANVILLE
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State | NJ
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Zip | 07751-2079
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Country | US
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Telephone | 732-443-0300
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Fax | 732-526-4150
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Authorized Official
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Title or Position | OWNER
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Name | DR. TASMIN LEE CORDIE
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Credential | DC
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Telephone | 324-443-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6626
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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