Provider Demographics
NPI:1598372906
Name:DUFFY, LAUREN MACKENZIE (MS, RDN)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:MACKENZIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1611
Mailing Address - Country:US
Mailing Address - Phone:732-996-7304
Mailing Address - Fax:
Practice Address - Street 1:212 BEACON BLVD
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1611
Practice Address - Country:US
Practice Address - Phone:732-996-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics