Provider Demographics
NPI:1306026810
Name:MCGURK, JENNIFER LYNN (RDN, CDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCGURK
Suffix:
Gender:F
Credentials:RDN, CDN, CDE
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:REGESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDN, CDE
Mailing Address - Street 1:99 MAIN STREET, SUITE 204
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:845-535-9092
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN STREET, SUITE 204
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-535-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL947891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered