Provider Demographics
NPI:1568700987
Name:HOMBERG, SUSAN LUEL (MS, CNS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LUEL
Last Name:HOMBERG
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2156
Mailing Address - Country:US
Mailing Address - Phone:201-664-8111
Mailing Address - Fax:
Practice Address - Street 1:139 3RD AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2156
Practice Address - Country:US
Practice Address - Phone:201-664-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education