Provider Demographics
NPI:1902160203
Name:GARDEN STATE NUTRITION & WELLNESS
Entity Type:Organization
Organization Name:GARDEN STATE NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROBE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:908-510-1365
Mailing Address - Street 1:220 ELMER ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2128
Mailing Address - Country:US
Mailing Address - Phone:908-510-1365
Mailing Address - Fax:201-455-6680
Practice Address - Street 1:220 ELMER ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2128
Practice Address - Country:US
Practice Address - Phone:908-510-1365
Practice Address - Fax:201-455-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ932870133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty