Provider Demographics
NPI:1770981516
Name:BIANCHINI, JENNIFER (MS, RD, CDN, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BIANCHINI
Suffix:
Gender:F
Credentials:MS, RD, CDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PENELOPE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5910
Mailing Address - Country:US
Mailing Address - Phone:888-383-5616
Mailing Address - Fax:
Practice Address - Street 1:119 S WESTERN AVE STE 213
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4643
Practice Address - Country:US
Practice Address - Phone:631-704-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007934-1133N00000X
NY1049759133V00000X
133V00000X
FLND7648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist