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General NPI Number Information
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NPI Number | 1265971261
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Entity Type | Organization
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Legal Business Name | TELADIETITIAN
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 471 NORTH BROADWAY, 363
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City | JERICHO
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State | NY
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Zip | 11753
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Country | US
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Telephone | 917-535-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 471 N BROADWAY # 363
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City | JERICHO
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State | NY
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Zip | 11753-2106
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Country | US
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Telephone | 917-535-3626
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACQUELINE ARNETT
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Credential | RD, ESQ.
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Telephone | 917-535-3626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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