Provider Demographics
NPI:1952832958
Name:VENTRE, JACLYN (RD)
Entity Type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:
Last Name:VENTRE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RIVERSIDE AVE
Mailing Address - Street 2:6J
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1067
Mailing Address - Country:US
Mailing Address - Phone:646-662-1087
Mailing Address - Fax:
Practice Address - Street 1:6 INDUSTRIAL WAY W
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2268
Practice Address - Country:US
Practice Address - Phone:908-338-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86021318133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered