Provider Demographics
NPI:1427107374
Name:ANDRUS, JENNIFER NOELLE (MS, RD, CDN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NOELLE
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E 42ND ST
Mailing Address - Street 2:SUITE 621
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5404
Mailing Address - Country:US
Mailing Address - Phone:212-541-7111
Mailing Address - Fax:646-417-7227
Practice Address - Street 1:51 E 42ND ST
Practice Address - Street 2:SUITE 621
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5404
Practice Address - Country:US
Practice Address - Phone:212-541-7111
Practice Address - Fax:646-417-7227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005250-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered