MEDICARE: SOUL CATERING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1477416204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL CATERING LLC

Provider Business Mailing Address
First Line	:	31 E 2ND ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-3403
Country	:	US
Telephone Number	:	973-417-2614
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 RENNER AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07112-2522
Country	:	US
Telephone Number	:	973-417-2614
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VICTORIA FUNN
Credential	:
Telephone Number	:	973-417-2614

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “SOUL CATERING LLC ” Practice Location

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