Provider Demographics
NPI:1124433818
Name:MOZIAN, LAURIE DEUTSCH (MS,RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:DEUTSCH
Last Name:MOZIAN
Suffix:
Gender:F
Credentials:MS,RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PRESIDENTS PL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6307
Mailing Address - Country:US
Mailing Address - Phone:845-340-9216
Mailing Address - Fax:
Practice Address - Street 1:15 PRESIDENTS PL
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6307
Practice Address - Country:US
Practice Address - Phone:845-340-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-22
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY817223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered