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General NPI Number Information
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NPI Number | 1578843827
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Entity Type | Individual
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Provider Name | SUSAN GENEROSE R.D.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 135 LAFAYETTE AVE
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City | PALMERTON
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State | PA
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Zip | 18071-1518
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Country | US
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Telephone | 610-826-1150
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Fax | 610-826-1211
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Provider Business Mailing Address
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Address Line | 10 HERITAGE CIR
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City | HAZLE TOWNSHIP
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State | PA
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Zip | 18202-2905
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Country | US
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Telephone | 570-401-5345
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Fax | 610-826-1211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | DN000681
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License Number State | PA
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