Healthcare Provider Details

I. General information

NPI: 1093939480
Provider Name (Legal Business Name): JEFFREY C ENSMINGER RD, CDE, CDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E 3RD ST
DUNKIRK NY
14048-2239
US

IV. Provider business mailing address

107 INSTITUTE ST
JAMESTOWN NY
14701-6628
US

V. Phone/Fax

Practice location:
  • Phone: 716-363-6050
  • Fax:
Mailing address:
  • Phone: 716-484-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number852929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: