Healthcare Provider Details

I. General information

NPI: 1508209032
Provider Name (Legal Business Name): JACQUELINE ARNETT R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE ARNETT R.D.

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 JERICHO TPKE
SYOSSET NY
11791-4544
US

IV. Provider business mailing address

62 MUTTONTOWN EASTWOODS RD
SYOSSET NY
11791-2401
US

V. Phone/Fax

Practice location:
  • Phone: 917-535-3626
  • Fax: 516-977-3367
Mailing address:
  • Phone: 917-535-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86011038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: