Healthcare Provider Details

I. General information

NPI: 1154545895
Provider Name (Legal Business Name): JENNIFER M WESTON PA-C, MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date: 10/09/2019
Reactivation Date: 11/04/2019

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

20302 ASPENWOOD DR
PLAINVIEW NY
11803-2145
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2400
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number023991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: