Provider Demographics
NPI:1730735200
Name:TABACHNICK, JENNIFER CONCETTA (RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CONCETTA
Last Name:TABACHNICK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CONCETTA
Other - Last Name:IOSUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 MASONIC AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2325
Mailing Address - Country:US
Mailing Address - Phone:516-521-8161
Mailing Address - Fax:
Practice Address - Street 1:16 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2325
Practice Address - Country:US
Practice Address - Phone:516-521-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered