Provider Demographics
NPI:1083785133
Name:GANS, KERI M (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:M
Last Name:GANS
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIVER RD # 616
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1916
Mailing Address - Country:US
Mailing Address - Phone:917-817-8776
Mailing Address - Fax:
Practice Address - Street 1:2 RIVER RD # 616
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1916
Practice Address - Country:US
Practice Address - Phone:917-817-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09Q771Medicare ID - Type Unspecified