Provider Demographics
NPI:1255226288
Name:WEINER, JACLYN RACHEL (RD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:RACHEL
Last Name:WEINER
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 1:27 BARKER AVE APT 702
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1563
Mailing Address - Country:US
Mailing Address - Phone:617-991-6986
Mailing Address - Fax:
Practice Address - Street 1:27 BARKER AVE APT 702
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1563
Practice Address - Country:US
Practice Address - Phone:617-991-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012380133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered