Provider Demographics
NPI:1528589553
Name:FRATINI, JENNIFER V (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:V
Last Name:FRATINI
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 1:21 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-2112
Mailing Address - Country:US
Mailing Address - Phone:856-430-7224
Mailing Address - Fax:
Practice Address - Street 1:21 BROOKVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051
Practice Address - Country:US
Practice Address - Phone:856-430-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ927474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered