MEDICARE: MRS. LAURA COLLEEN KUMAR RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1010307	NJ
2	133V00000X	Registered Dietitian		NJ

General Provider Information

NPI Number	:	1659606036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA COLLEEN KUMAR RD

Provider Business Mailing Address
First Line	:	412 NEWARK AVE
Second Line	:
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1537
Country	:	US
Telephone Number	:	732-991-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 NEWARK AVE
Second Line	:
City	:	BRADLEY BEACH
State	:	NJ
Zip	:	07720-1537
Country	:	US
Telephone Number	:	732-991-7406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	06/04/2024

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