MEDICARE: LAUREN KOCH 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
2	133V00000X	Registered Dietitian	164008410	IL
3	133V00000X	Registered Dietitian	DT87050	TX
4	133V00000X	Registered Dietitian	LD-D-10260639	OR

General Provider Information

NPI Number	:	1710799879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN KOCH RD

Provider Business Mailing Address
First Line	:	39 SUN VALLEY WAY
Second Line	:
City	:	MORRIS PLAINS
State	:	NJ
Zip	:	07950-1913
Country	:	US
Telephone Number	:	817-600-5465
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 SUN VALLEY WAY
Second Line	:
City	:	MORRIS PLAINS
State	:	NJ
Zip	:	07950-1913
Country	:	US
Telephone Number	:	817-600-5465
Fax Number	:

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

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/07/2026

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