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General NPI Number Information
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NPI Number | 1609415520
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Entity Type | Organization
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Legal Business Name | BEACON HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 802 OLD SPRINGFIELD AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-1130
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Country | US
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Telephone | 908-333-4665
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Fax |
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Provider Business Mailing Address
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Address Line | 802 OLD SPRINGFIELD AVE
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City | SUMMIT
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State | NJ
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Zip | 07901-1130
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Country | US
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Telephone | 908-333-4665
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | DR. SHAKTHI KUMAR
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Credential | DHA
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Telephone | 908-333-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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