Provider Demographics
NPI:1750375457
Name:LANZISERA, BETH A
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:LANZISERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2432
Mailing Address - Country:US
Mailing Address - Phone:908-497-1469
Mailing Address - Fax:
Practice Address - Street 1:51 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2432
Practice Address - Country:US
Practice Address - Phone:908-497-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ943474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ943474OtherCDR REGISTRATION NUMBER