Provider Demographics
NPI:1912271909
Name:BAUNACH, JANICE (RD)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:BAUNACH
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 1:94 STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1490
Mailing Address - Country:US
Mailing Address - Phone:732-914-1100
Mailing Address - Fax:732-797-3809
Practice Address - Street 1:94 STEVENS RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1490
Practice Address - Country:US
Practice Address - Phone:732-914-1100
Practice Address - Fax:732-797-3809
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ630124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered