Healthcare Provider Details

I. General information

NPI: 1699398149
Provider Name (Legal Business Name): JACLYN PHILBIN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN OCCHICONE RDN

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 NEW BRUNSWICK RD
SOMERSET NJ
08873-5223
US

IV. Provider business mailing address

705 NEW BRUNSWICK RD
SOMERSET NJ
08873-5223
US

V. Phone/Fax

Practice location:
  • Phone: 973-668-8410
  • Fax:
Mailing address:
  • Phone: 973-668-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: