Provider Demographics
NPI:1992943229
Name:BORNSTEIN, JAIMIE MARISA (MPH, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:MARISA
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:MPH, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NORMAN CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5812
Mailing Address - Country:US
Mailing Address - Phone:917-690-7945
Mailing Address - Fax:
Practice Address - Street 1:6 NORMAN CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5812
Practice Address - Country:US
Practice Address - Phone:631-424-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY872924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY872924OtherCERTIFIED DIETITIAN NUTRITIONIST