Provider Demographics
NPI:1417140005
Name:SUGARMAN, KRISTEN MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 WITHERSPOON ST
Mailing Address - Street 2:EATING DISORDERS PROGRAM
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3211
Mailing Address - Country:US
Mailing Address - Phone:609-497-4000
Mailing Address - Fax:609-497-4412
Practice Address - Street 1:253 WITHERSPOON ST
Practice Address - Street 2:EATING DISORDERS PROGRAM
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:609-497-4000
Practice Address - Fax:609-497-4412
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ912449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered