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General NPI Number Information
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NPI Number | 1659630598
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Entity Type | Organization
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Legal Business Name | COMPLETE NUTRITION & WELLNESS
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Dates
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Enumeration Date | 05/13/2012
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Last Update Date | 05/13/2012
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Provider Practice Location Address
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Address Line | 80 PARK AVE
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City | HOBOKEN
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State | NJ
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Zip | 07030-3572
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Country | US
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Telephone | 201-238-2720
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Fax | 201-526-4684
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Provider Business Mailing Address
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Address Line | 80 PARK AVE
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City | HOBOKEN
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State | NJ
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Zip | 07030-3572
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Country | US
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Telephone | 201-238-2720
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Fax | 201-526-4684
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Authorized Official
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Title or Position | REGISTERED DIETICIAN
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Name | MRS. ELIZABETH SWICK
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Credential | RD
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Telephone | 201-238-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1022771
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License Number State | NJ
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