Provider Demographics
NPI:1992340251
Name:KHETTRY, LAURA ROLFE (MS, RDN, CDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ROLFE
Last Name:KHETTRY
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MADISON PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3040
Mailing Address - Country:US
Mailing Address - Phone:610-310-0040
Mailing Address - Fax:
Practice Address - Street 1:145 MADISON PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3040
Practice Address - Country:US
Practice Address - Phone:610-310-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86031706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered