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General NPI Number Information
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NPI Number | 1487044673
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Entity Type | Organization
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Legal Business Name | COMFORT NUTRITION SERVICES LLC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 397 BRIDGETON PIKE
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City | MANTUA
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State | NJ
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Zip | 08051-1925
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Country | US
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Telephone | 856-625-6607
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Fax |
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Provider Business Mailing Address
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Address Line | 397 BRIDGETON PIKE
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City | MANTUA
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State | NJ
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Zip | 08051-1925
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Country | US
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Telephone | 856-625-6607
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADEKEMI ADEJARE
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Credential | RD
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Telephone | 856-625-6607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 945345
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License Number State | NJ
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