Provider Demographics
NPI:1710799879
Name:KOCH, LAUREN (RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SUN VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1913
Mailing Address - Country:US
Mailing Address - Phone:817-600-5465
Mailing Address - Fax:
Practice Address - Street 1:39 SUN VALLEY WAY
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1913
Practice Address - Country:US
Practice Address - Phone:817-600-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87050133V00000X
IL164008410133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered