Provider Demographics
NPI:1699398149
Name:PHILBIN, JACLYN (RDN)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:PHILBIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MIDDLEBURY BOULEVARD
Mailing Address - Street 2:SUITE 9/10
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-668-8410
Mailing Address - Fax:
Practice Address - Street 1:11 MIDDLEBURY BOULEVARD
Practice Address - Street 2:SUITE 9/10
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-668-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered