Healthcare Provider Details

I. General information

NPI: 1770390395
Provider Name (Legal Business Name): STEFANIE JASKOT RDN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE FL 3
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

30 PROSPECT AVE FL 3
HACKENSACK NJ
07601-1915
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2000
  • Fax:
Mailing address:
  • Phone: 551-996-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1098232
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1098232
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: