Individual
MRS. JACQUELINE E MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CDN
Contact information
Practice address
13 AVENUE LOUISE, MASSAPEQUA PARK, NY 11762-3207
(516) 236-3984
Mailing address
13 AVENUE LOUISE, MASSAPEQUA PARK, NY 11762-3207
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
006357
NY
Other
Enumeration date
09/06/2011
Last updated
09/06/2011
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