=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073334298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMINE LUCIANO RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 999 BLAKE AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11208-3535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-566-6278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 MADISON AVE FL 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-545-2400
-----------------------------------------------------
Fax | 212-463-8411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 012372-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------