Provider Demographics
NPI:1821303124
Name:ELIASI-TEICH, JENNIFER R (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:ELIASI-TEICH
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 66TH RD
Mailing Address - Street 2:11F
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2000
Mailing Address - Country:US
Mailing Address - Phone:718-997-1899
Mailing Address - Fax:
Practice Address - Street 1:10210 66TH RD
Practice Address - Street 2:11F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2000
Practice Address - Country:US
Practice Address - Phone:718-997-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered