Provider Demographics
NPI:1275194292
Name:BANKS, JANNA Y (RD, CDN, CDCES)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:Y
Last Name:BANKS
Suffix:
Gender:F
Credentials:RD, CDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 MADISON AVE.
Mailing Address - Street 2:ANNENBERG, 4TH FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2192
Mailing Address - Country:US
Mailing Address - Phone:212-241-6936
Mailing Address - Fax:
Practice Address - Street 1:1468 MADISON AVE.
Practice Address - Street 2:ANNENBERG, 4TH FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2192
Practice Address - Country:US
Practice Address - Phone:347-346-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NY008425-01133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric