Provider Demographics
NPI:1114614062
Name:GIACINTO, JEANETTE (RD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:GIACINTO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W MARKET ST UPPR UNIT
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1718
Mailing Address - Country:US
Mailing Address - Phone:516-320-1295
Mailing Address - Fax:
Practice Address - Street 1:633 W MARKET ST UPPR UNIT
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1718
Practice Address - Country:US
Practice Address - Phone:516-320-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86102940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered