Provider Demographics
NPI:1043543770
Name:TOMEZSKO, JEAN ELENA (PHD, RD, LDN)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ELENA
Last Name:TOMEZSKO
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PRINCE EUGENE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5211
Mailing Address - Country:US
Mailing Address - Phone:610-565-2989
Mailing Address - Fax:
Practice Address - Street 1:4 PRINCE EUGENE LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5211
Practice Address - Country:US
Practice Address - Phone:610-565-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
719831133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
719831OtherREGISTERED DIETITIAN
PADN001051OtherLICENSED DIETITIAN-NUTRITIONIST