Provider Demographics
NPI:1205433257
Name:SUE LISCHUK RD LLC
Entity type:Organization
Organization Name:SUE LISCHUK RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LISCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:484-876-1447
Mailing Address - Street 1:341 EAST LANCASTER AVENUE
Mailing Address - Street 2:2ND FLOOR EAST
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:484-876-1447
Mailing Address - Fax:484-848-5183
Practice Address - Street 1:341 EAST LANCASTER AVENUE
Practice Address - Street 2:2ND FLOOR EAST
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:484-876-1447
Practice Address - Fax:484-848-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty