Healthcare Provider Details

I. General information

NPI: 1780690461
Provider Name (Legal Business Name): JACINTA SNAGG BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HUDSON ST 2ND FLOOR
NEW YORK NY
10013-1009
US

IV. Provider business mailing address

315 HUDSON ST 2ND FLOOR
NEW YORK NY
10013-1009
US

V. Phone/Fax

Practice location:
  • Phone: 917-606-6610
  • Fax:
Mailing address:
  • Phone: 917-606-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number004742-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: