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General NPI Number Information
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NPI Number | 1265857957
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE FUNCTIONAL NUTRITION AND FITNESS, LLC
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 217 MORRIS AVE SUITE 2C
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City | SPRING LAKE
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State | NJ
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Zip | 07762-1336
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Country | US
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Telephone | 732-449-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 217 MORRIS AVE SUITE 2C
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City | SPRING LAKE
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State | NJ
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Zip | 07762-1336
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Country | US
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Telephone | 732-449-4040
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Fax |
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Authorized Official
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Title or Position | CLINICAL NUTRITIONIST
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Name | MRS. FRANCES HENIG
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Credential | RD
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Telephone | 732-449-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 816010
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License Number State | NJ
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