Provider Demographics
NPI:1083168231
Name:KAISER, JEANNINE (MS, RD, CDCES)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 WEST 4TH ST APT 22
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:917-704-5182
Mailing Address - Fax:
Practice Address - Street 1:40 W 4TH ST APT 22
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2124
Practice Address - Country:US
Practice Address - Phone:917-704-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2024-12-11
Deactivation Date:2020-09-16
Deactivation Code:
Reactivation Date:2024-11-14
Provider Licenses
StateLicense IDTaxonomies
NY1049577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered