Provider Demographics
NPI:1992217483
Name:LEBOVITS, JESSICA ARIEL (RD, CDN, CNSC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ARIEL
Last Name:LEBOVITS
Suffix:
Gender:F
Credentials:RD, CDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MAYTIME DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:186 MAYTIME DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2251
Practice Address - Country:US
Practice Address - Phone:516-640-2946
Practice Address - Fax:877-819-2427
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86030776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered