Provider Demographics
NPI:1710335518
Name:RATH, JENNA (MS, RD)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:
Last Name:RATH
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 1:2544 NIAGARA RD
Mailing Address - Street 2:LWR
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2021
Mailing Address - Country:US
Mailing Address - Phone:716-909-7661
Mailing Address - Fax:
Practice Address - Street 1:200 OHIO ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1063
Practice Address - Country:US
Practice Address - Phone:585-798-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86040563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered