Provider Demographics
NPI:1386203909
Name:NG, JEANNIE (MPH, RDN, CDN)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:MPH, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 STEINWAY ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1648
Mailing Address - Country:US
Mailing Address - Phone:864-946-9264
Mailing Address - Fax:
Practice Address - Street 1:2067 STEINWAY ST APT 2R
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1648
Practice Address - Country:US
Practice Address - Phone:864-946-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008190133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty