Provider Demographics
NPI:1285946665
Name:KRAUS, SUSAN JODIE (MSRD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JODIE
Last Name:KRAUS
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-22 SUMNER PL
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4223
Mailing Address - Country:US
Mailing Address - Phone:551-206-2126
Mailing Address - Fax:
Practice Address - Street 1:12-22 SUMNER PL
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4223
Practice Address - Country:US
Practice Address - Phone:551-206-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic