Provider Demographics
NPI:1033539697
Name:JEANNINE ANDRE-BURNS NUTRITION SERVICES, INC.
Entity Type:Organization
Organization Name:JEANNINE ANDRE-BURNS NUTRITION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRE-BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-305-4425
Mailing Address - Street 1:1530 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4501
Mailing Address - Country:US
Mailing Address - Phone:860-305-4425
Mailing Address - Fax:
Practice Address - Street 1:9408 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3742
Practice Address - Country:US
Practice Address - Phone:860-305-4425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16130133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty