Healthcare Provider Details

I. General information

NPI: 1992832216
Provider Name (Legal Business Name): WENDY L KUCZYNSKI RD, CNSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MADISON AVE SUITE 50
PARAMUS NJ
07652-2722
US

IV. Provider business mailing address

1364 OXFORD ST
MAHWAH NJ
07430-3260
US

V. Phone/Fax

Practice location:
  • Phone: 201-970-4121
  • Fax: 866-391-3047
Mailing address:
  • Phone: 201-970-4121
  • Fax: 866-391-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number875777
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: