Provider Demographics
NPI:1407328651
Name:CLEMENTE, JENNIFER ANN (MS, CNS, CDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:MS, CNS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CLINTON AVE APT 11A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1160
Mailing Address - Country:US
Mailing Address - Phone:917-602-6086
Mailing Address - Fax:
Practice Address - Street 1:168 PONQUOGUE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-3071
Practice Address - Country:US
Practice Address - Phone:646-564-3818
Practice Address - Fax:646-461-4447
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011003133N00000X
NYCNS17054133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty