Nutricultures Nutrition and Diabetes Center LLC

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

Legal business name

NUTRICULTURES NUTRITION AND DIABETES CENTER LLC

Practice address

292 Bloomfield Ave FL 2
Montclair, NJ 07042-3624

Phone

(201) 207-2158

NPI assigned

Mar 12, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mercy K Edziah, MS, RD, CDCESNPI 1881152510

Title

Owner/Consultant

Phone

(201) 207-2158

Specialties & licenses 1

Addresses

Other names 1

• NutriCultures Other name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mercy K. Edziah, MS, RD, CDCES

  • Registered Dietitian
  • Newark, NJ
  • NPI 1881152510
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1194284844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "292 BLOOMFIELD AVE FL 2",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423624",
            "telephone_number": "201-207-2158",
            "fax_number": "201-604-4639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "292 BLOOMFIELD AVE FL 2",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423624",
            "telephone_number": "201-207-2158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRICULTURES NUTRITION AND DIABETES CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "EDZIAH",
        "authorized_official_first_name": "MERCY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/CONSULTANT",
        "authorized_official_telephone_number": "201-207-2158",
        "authorized_official_credential": "MS, RD, CDCES"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NutriCultures",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NutriCultures",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Metabolic Nutrition Registered Dietitian in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Metabolic Nutrition Registered Dietitian in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.