Provider Demographics
NPI:1952525404
Name:YACHECHAK, SUZANNE M (MS,RD)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:M
Last Name:YACHECHAK
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2203
Mailing Address - Country:US
Mailing Address - Phone:201-487-6564
Mailing Address - Fax:201-880-4124
Practice Address - Street 1:180 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2203
Practice Address - Country:US
Practice Address - Phone:201-487-6564
Practice Address - Fax:201-880-4124
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered