MEDICARE: MS. LINDA BROOKS CERTIFIED WEIGHT LOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133NN1002X	Nutrition Education Nutritionist
2	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
3	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1033726658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA BROOKS CERTIFIED WEIGHT LOS

Provider Business Mailing Address
First Line	:	1926 TROY DR
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-3662
Country	:	US
Telephone Number	:	732-859-7400
Fax Number	:	732-449-5871

Provider Business Practice Location Address
First Line	:	309 MORRIS AVENUE
Second Line	:	SUITE F
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-1533
Country	:	US
Telephone Number	:	732-859-7400
Fax Number	:	732-499-5871

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	06/07/2022

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