Provider Demographics
NPI:1013192285
Name:DUDA, JENNIFER ANDREA (RD)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ANDREA
Last Name:DUDA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1265 PATERSON PLANK RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094
Mailing Address - Country:US
Mailing Address - Phone:201-456-5657
Mailing Address - Fax:201-955-2127
Practice Address - Street 1:1265 PATERSON PLANK RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-456-5657
Practice Address - Fax:201-955-2127
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ922627133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered