Provider Demographics
NPI:1225573975
Name:BUONFIGLIO MEYER, JACLYN MARIE (MS, RDN, CDE)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:BUONFIGLIO MEYER
Suffix:
Gender:F
Credentials:MS, RDN, CDE
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RDN, CDE
Mailing Address - Street 1:37 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2902
Mailing Address - Country:US
Mailing Address - Phone:845-334-4249
Mailing Address - Fax:845-334-4342
Practice Address - Street 1:37 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2902
Practice Address - Country:US
Practice Address - Phone:845-334-4342
Practice Address - Fax:845-334-4342
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY974309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered