MEDICARE: JENNA LEBOWICH MS, RDN, CDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	008806	NY

General Provider Information

NPI Number	:	1255874137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LEBOWICH MS, RDN, CDN

Provider Business Mailing Address
First Line	:	9 BURLING AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-3508
Country	:	US
Telephone Number	:	914-997-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 BURLING AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-3508
Country	:	US
Telephone Number	:	914-997-0194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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