Provider Demographics
NPI:1265971261
Name:TELADIETITIAN
Entity type:Organization
Organization Name:TELADIETITIAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RD, ESQ
Authorized Official - Phone:917-535-3626
Mailing Address - Street 1:471 N BROADWAY # 363
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2106
Mailing Address - Country:US
Mailing Address - Phone:917-535-3626
Mailing Address - Fax:
Practice Address - Street 1:471 NORTH BROADWAY, 363
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753
Practice Address - Country:US
Practice Address - Phone:917-535-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty