Provider Demographics
NPI:1285938324
Name:RICHTER, SUSAN (RN, CNC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:RICHTER
Suffix:
Gender:F
Credentials:RN, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W MAIN ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2174
Mailing Address - Country:US
Mailing Address - Phone:973-586-0626
Mailing Address - Fax:973-784-3580
Practice Address - Street 1:166 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1537
Practice Address - Country:US
Practice Address - Phone:973-586-0626
Practice Address - Fax:973-784-3580
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10942600133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education