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General NPI Number Information
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NPI Number | 1427683192
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Entity Type | Organization
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Legal Business Name | TEACHING FENIX RDN CAFE LLC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 100 ENTERPRISE DR STE 301
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City | ROCKAWAY
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State | NJ
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Zip | 07866-2129
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Country | US
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Telephone | 973-206-2130
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Fax | 973-385-1650
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Provider Business Mailing Address
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Address Line | 100 ENTERPRISE DR STE 301
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City | ROCKAWAY
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State | NJ
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Zip | 07866-2129
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Country | US
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Telephone | 973-206-2130
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Fax | 973-385-1650
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Authorized Official
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Title or Position | OWNER, PROVIDER, SINGLE MEMBER LLC
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Name | MS. CYNTHIA L LOPEZ-PETTORINO
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Credential | RDN, CDE
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Telephone | 973-206-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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