Provider Demographics
NPI:1740601392
Name:MACHOWSKY, JASON (RD, CSSD, CSCS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MACHOWSKY
Suffix:
Gender:M
Credentials:RD, CSSD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 COLES ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1918
Mailing Address - Country:US
Mailing Address - Phone:732-887-2082
Mailing Address - Fax:
Practice Address - Street 1:132 COLES ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1918
Practice Address - Country:US
Practice Address - Phone:732-887-2082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered