Provider Demographics
NPI:1487264719
Name:PADOVANO, JACLYN JOSEPHINE (RD, CDN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:JOSEPHINE
Last Name:PADOVANO
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1927
Mailing Address - Country:US
Mailing Address - Phone:201-655-5697
Mailing Address - Fax:
Practice Address - Street 1:385 TERRACE LN
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1927
Practice Address - Country:US
Practice Address - Phone:201-655-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X, 133V00000X
NJ86051906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education