Provider Demographics
NPI:1992832216
Name:KUCZYNSKI, WENDY L (RD, CNSD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:KUCZYNSKI
Suffix:
Gender:F
Credentials:RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3260
Mailing Address - Country:US
Mailing Address - Phone:201-970-4121
Mailing Address - Fax:866-391-3047
Practice Address - Street 1:27 MADISON AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2722
Practice Address - Country:US
Practice Address - Phone:201-970-4121
Practice Address - Fax:866-391-3047
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ875777133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered