Provider Demographics
NPI:1780952705
Name:HORAN, KAREN LYNN (RD, CDE)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:HORAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 EDGEWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-736-4717
Mailing Address - Fax:201-444-8177
Practice Address - Street 1:61 NORTH MAPLE AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-8110
Practice Address - Fax:201-444-8177
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ838532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered