Provider Demographics
NPI:1881017986
Name:FREY, JENNIFER (RD, CDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:174 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3212
Mailing Address - Country:US
Mailing Address - Phone:516-944-0500
Mailing Address - Fax:516-944-0501
Practice Address - Street 1:174 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3212
Practice Address - Country:US
Practice Address - Phone:516-944-0500
Practice Address - Fax:516-944-0501
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY723130133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered