Provider Demographics
NPI:1104087691
Name:PATLA, SUSAN (MS RD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:PATLA
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 1:12 DANIEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2742
Mailing Address - Country:US
Mailing Address - Phone:732-583-3022
Mailing Address - Fax:732-583-3022
Practice Address - Street 1:12 DANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2742
Practice Address - Country:US
Practice Address - Phone:732-583-3022
Practice Address - Fax:732-583-3022
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered