Provider Demographics
NPI:1578843827
Name:GENEROSE, SUSAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:GENEROSE
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 1:10 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-2905
Mailing Address - Country:US
Mailing Address - Phone:570-401-5345
Mailing Address - Fax:610-826-1211
Practice Address - Street 1:135 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1518
Practice Address - Country:US
Practice Address - Phone:610-826-1150
Practice Address - Fax:610-826-1211
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000681133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic