Provider Demographics
NPI:1558029744
Name:JANUSZANIS, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:JANUSZANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SUNRISE TER
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1423
Mailing Address - Country:US
Mailing Address - Phone:973-356-5075
Mailing Address - Fax:
Practice Address - Street 1:716 BROAD ST STE 2E
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1645
Practice Address - Country:US
Practice Address - Phone:973-910-1533
Practice Address - Fax:973-777-7938
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86092264133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered