Healthcare Provider Details

I. General information

NPI: 1952525404
Provider Name (Legal Business Name): SUZANNE M YACHECHAK MS,RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 OVERLOOK AVE
HACKENSACK NJ
07601-2203
US

IV. Provider business mailing address

180 OVERLOOK AVE
HACKENSACK NJ
07601-2203
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-6564
  • Fax: 201-880-4124
Mailing address:
  • Phone: 201-487-6564
  • Fax: 201-880-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: