Provider Demographics
NPI:1093939480
Name:ENSMINGER, JEFFREY C (RD, CDE, CDN)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:ENSMINGER
Suffix:
Gender:M
Credentials:RD, CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DEEPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1426
Mailing Address - Country:US
Mailing Address - Phone:716-908-9434
Mailing Address - Fax:
Practice Address - Street 1:574 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1751
Practice Address - Country:US
Practice Address - Phone:716-608-3110
Practice Address - Fax:716-674-1148
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY852929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered