Provider Demographics
NPI:1639607443
Name:ROCK, JENNIFER (MS, RD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3100
Mailing Address - Country:US
Mailing Address - Phone:908-797-4622
Mailing Address - Fax:
Practice Address - Street 1:100 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3100
Practice Address - Country:US
Practice Address - Phone:908-797-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86004013133V00000X
NY009165133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered