Provider Demographics
NPI:1477813038
Name:JACOBI, ARLENE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:MARIE
Last Name:JACOBI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 BURNS ST APT 5G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3509
Mailing Address - Country:US
Mailing Address - Phone:201-320-4589
Mailing Address - Fax:
Practice Address - Street 1:6510 99TH ST
Practice Address - Street 2:SUITE LL1
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3569
Practice Address - Country:US
Practice Address - Phone:201-320-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY945288133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric