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: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 MAIN ST SUITE 203
EAST AURORA NY
14052-1751
US

IV. Provider business mailing address

55 DEEPWOOD DR
EAST AURORA NY
14052-1426
US

V. Phone/Fax

Practice location:
  • Phone: 716-608-3110
  • Fax: 716-674-1148
Mailing address:
  • Phone: 716-908-9434
  • 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: