=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922512169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LZ NUTRITION SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2017
-----------------------------------------------------
Last Update Date | 11/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 DUNHAMS CORNER RD
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-254-0113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 SHIRA LN
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED DIETITIAN
-----------------------------------------------------
Name | LORENA ZACCHINO
-----------------------------------------------------
Credential | RDN
-----------------------------------------------------
Telephone | 973-432-9597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 932867
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------