Provider Demographics
NPI:1578919718
Name:WESTCHESTER WELLNESS NUTRITION PLLC
Entity Type:Organization
Organization Name:WESTCHESTER WELLNESS NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:908-358-9720
Mailing Address - Street 1:1 PIER POINTE ST
Mailing Address - Street 2:ST. 919F
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3569
Mailing Address - Country:US
Mailing Address - Phone:908-935-8972
Mailing Address - Fax:
Practice Address - Street 1:1 PIER POINTE ST
Practice Address - Street 2:ST. 919F
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3569
Practice Address - Country:US
Practice Address - Phone:908-935-8972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty