Provider Demographics
NPI:1093053621
Name:HODGE, KAREN J (RD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:HODGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:180 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 7B
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4569
Practice Address - Country:US
Practice Address - Phone:732-935-7143
Practice Address - Fax:732-935-7245
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ588876133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered