Provider Demographics
NPI:1184340762
Name:LAZAR, JACQUELINE (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:DAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CDN
Mailing Address - Street 1:1266 OCEAN PKWY APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5102
Mailing Address - Country:US
Mailing Address - Phone:917-589-7900
Mailing Address - Fax:
Practice Address - Street 1:1266 OCEAN PKWY APT 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5102
Practice Address - Country:US
Practice Address - Phone:917-589-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011142133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered