Provider Demographics
NPI:1588626188
Name:HAGER, LORI (RD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HAGER
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 1:77 BRANT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1540
Mailing Address - Country:US
Mailing Address - Phone:732-382-0091
Mailing Address - Fax:732-382-8570
Practice Address - Street 1:1511 PARK AVE FL 2
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5568
Practice Address - Country:US
Practice Address - Phone:908-427-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
918598133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP60640Medicare UPIN
NJ058595Medicare ID - Type Unspecified