# BEACON HEALTH SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beacon Health Sciences
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609415520
- **Authorized official:** DR. SHAKTHI KUMAR DHA (FOUNDER & CEO)
- **Authorized official phone:** (908) 333-4665

## Contact information

- **Practice address:** 802 OLD SPRINGFIELD AVE, SUMMIT, NJ 07901-1130
- **Practice address phone:** (908) 333-4665
- **Mailing address:** 802 OLD SPRINGFIELD AVE, SUMMIT, NJ 07901-1130
- **Mailing address phone:** (908) 333-4665

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133N00000X | Nutritionist | — | NULL | — |
| 133N00000X | Nutritionist | — | — | — |
| 170100000X | Ph.D. Medical Genetics | — | NULL | — |
| 170100000X | Ph.D. Medical Genetics | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/23/2019
- **Last updated:** 12/23/2019