=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275677312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN RUTH KRANTZ M.A. , R.D., C.D.E.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 03/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 NEW RD
-----------------------------------------------------
City | LINWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08221-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-226-8893
-----------------------------------------------------
Fax | 609-927-0668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 334 W OCEAN HEIGHTS AVE UNIT 114
-----------------------------------------------------
City | LINWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08221-1464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-927-1473
-----------------------------------------------------
Fax | 609-927-0668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------