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General NPI Number Information
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NPI Number | 1740601335
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Entity Type | Organization
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Legal Business Name | I C HEALTH BEYOND, LLC
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 1116 SUN VALLEY WAY
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-3049
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Country | US
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Telephone | 973-477-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 SUN VALLEY WAY
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-3049
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Country | US
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Telephone | 973-477-7732
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CARLA ROGERS
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Credential |
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Telephone | 973-477-7732
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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 | NJ
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