Provider Demographics
NPI: | 1871870188 |
---|---|
Name: | VALERIE KOREN NUTRITION |
Entity type: | Organization |
Organization Name: | VALERIE KOREN NUTRITION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REGISTERED DIETITIAN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VALERIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KOREN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RD |
Authorized Official - Phone: | 973-699-3342 |
Mailing Address - Street 1: | 2 BEECHCROFT RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SHORT HILLS |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07078-1627 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-699-3342 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2 BEECHCROFT RD |
Practice Address - Street 2: | |
Practice Address - City: | SHORT HILLS |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07078-1627 |
Practice Address - Country: | US |
Practice Address - Phone: | 973-699-3342 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-11-15 |
Last Update Date: | 2011-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 922140 | 133V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty |