Provider Demographics
NPI:1720827231
Name:JAG NUTRITION PLLC
Entity type:Organization
Organization Name:JAG NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:347-723-4043
Mailing Address - Street 1:121 TARA DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2727
Mailing Address - Country:US
Mailing Address - Phone:347-723-4043
Mailing Address - Fax:
Practice Address - Street 1:121 TARA DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2727
Practice Address - Country:US
Practice Address - Phone:347-723-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty