Provider Demographics
NPI:1063539526
Name:ANTHONY, SUSAN TANI (RD)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TANI
Last Name:ANTHONY
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 1:6 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3357
Mailing Address - Country:US
Mailing Address - Phone:973-359-8581
Mailing Address - Fax:973-359-8581
Practice Address - Street 1:6 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-3357
Practice Address - Country:US
Practice Address - Phone:973-359-8581
Practice Address - Fax:973-359-8581
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL955326133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered