Provider Demographics
NPI:1174996425
Name:LOUL, KALID M (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:KALID
Middle Name:M
Last Name:LOUL
Suffix:
Gender:M
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4991 ROUTE 42
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1750
Mailing Address - Country:US
Mailing Address - Phone:856-740-9777
Mailing Address - Fax:
Practice Address - Street 1:4991 ROUTE 42
Practice Address - Street 2:SUITE 8
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1750
Practice Address - Country:US
Practice Address - Phone:856-740-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86012841133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education