Provider Demographics
NPI:1619459971
Name:STAUBER, BRACHA (RDN)
Entity type:Individual
Prefix:MRS
First Name:BRACHA
Middle Name:
Last Name:STAUBER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ZINFANDEL RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4672
Mailing Address - Country:US
Mailing Address - Phone:732-367-4271
Mailing Address - Fax:
Practice Address - Street 1:38 ZINFANDEL RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4672
Practice Address - Country:US
Practice Address - Phone:773-349-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86063615133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered