Provider Demographics
NPI:1205278652
Name:LAURELTON, AUDREY (RD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:LAURELTON
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 1:427 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3583
Mailing Address - Country:US
Mailing Address - Phone:973-744-3555
Mailing Address - Fax:
Practice Address - Street 1:427 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3583
Practice Address - Country:US
Practice Address - Phone:973-744-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered