Provider Demographics
NPI:1356810022
Name:MAENG, JENNIFER J (MS, RD, CDN, CNSC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:J
Last Name:MAENG
Suffix:
Gender:F
Credentials:MS, 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 1:138 W 17TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5412
Mailing Address - Country:US
Mailing Address - Phone:908-906-4424
Mailing Address - Fax:
Practice Address - Street 1:138 W 17TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5412
Practice Address - Country:US
Practice Address - Phone:908-906-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86033494133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered