Provider Demographics
NPI:1306591698
Name:LAUBENSTEIN, GRACE LORRAINE (RDN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LORRAINE
Last Name:LAUBENSTEIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-341-8250
Mailing Address - Fax:856-341-8251
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 470D
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4002
Practice Address - Country:US
Practice Address - Phone:856-341-8250
Practice Address - Fax:856-341-8251
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered