Provider Demographics
NPI:1912697665
Name:SUSAN MARKOWITZ, RD
Entity type:Organization
Organization Name:SUSAN MARKOWITZ, RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:908-642-1592
Mailing Address - Street 1:759 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1536
Mailing Address - Country:US
Mailing Address - Phone:908-642-1592
Mailing Address - Fax:
Practice Address - Street 1:112 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2650
Practice Address - Country:US
Practice Address - Phone:908-642-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty