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General NPI Number Information
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NPI Number | 1922545953
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Entity Type | Organization
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Legal Business Name | WELL BALANCED NUTRITION, LLC
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Dates
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Enumeration Date | 01/29/2017
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Last Update Date | 01/29/2017
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Provider Practice Location Address
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Address Line | 7 GULF RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1362
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Country | US
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Telephone | 732-672-1768
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GULF RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MELANIE BLATTEIS
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Credential |
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Telephone | 732-672-1768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 000637-1
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License Number State | NY
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