Provider Demographics
NPI:1427591593
Name:KAUFMAN, JORDAN RAE (RD, CDN, LDN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RAE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:RD, CDN, LDN
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:RAE
Other - Last Name:ELLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN, LDN
Mailing Address - Street 1:400 K ST NW APT 516
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3083
Mailing Address - Country:US
Mailing Address - Phone:914-588-9643
Mailing Address - Fax:
Practice Address - Street 1:400 K ST NW APT 516
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3083
Practice Address - Country:US
Practice Address - Phone:914-588-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86026946133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered