Provider Demographics
NPI:1699450536
Name:LURIA, CHAYA R (RDN)
Entity type:Individual
Prefix:
First Name:CHAYA
Middle Name:R
Last Name:LURIA
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 1:156 VINTAGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3695
Mailing Address - Country:US
Mailing Address - Phone:848-210-1598
Mailing Address - Fax:
Practice Address - Street 1:205 WYNATT ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4839
Practice Address - Country:US
Practice Address - Phone:848-210-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86171594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered