Provider Demographics
NPI:1407803604
Name:SCHLUSSEL, LAURIE (RD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SCHLUSSEL
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 1:11 MARZ RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8217
Mailing Address - Country:US
Mailing Address - Phone:201-573-0397
Mailing Address - Fax:201-573-0397
Practice Address - Street 1:11 MARZ RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8217
Practice Address - Country:US
Practice Address - Phone:201-573-0397
Practice Address - Fax:201-573-0397
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ427130133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054290Medicare ID - Type Unspecified