Provider Demographics
NPI:1538388350
Name:BOROCZKY, SUSANN CAROLINE (RD, CD-N)
Entity type:Individual
Prefix:
First Name:SUSANN
Middle Name:CAROLINE
Last Name:BOROCZKY
Suffix:
Gender:F
Credentials:RD, CD-N
Other - Prefix:
Other - First Name:SUSANN
Other - Middle Name:
Other - Last Name:KRASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD-N
Mailing Address - Street 1:122 PLATT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5731
Mailing Address - Country:US
Mailing Address - Phone:203-937-5258
Mailing Address - Fax:
Practice Address - Street 1:111 GOOSE LN
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-5101
Practice Address - Country:US
Practice Address - Phone:203-453-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000582133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02658Medicare ID - Type UnspecifiedYNHH MEDICARE NUMBER