Provider Demographics
NPI:1811394661
Name:HART, JENNIFER L (RD, CDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5604
Mailing Address - Country:US
Mailing Address - Phone:315-436-7121
Mailing Address - Fax:
Practice Address - Street 1:1900 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5604
Practice Address - Country:US
Practice Address - Phone:315-436-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered