Individual
MS. JACQUELINE L BROCKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDN, CLT
Contact information
Practice address
1818 NEWKIRK AVE, APT 6W, BROOKLYN, NY 11226-7359
(561) 827-0372
Mailing address
1818 NEWKIRK AVE, APT 6W, BROOKLYN, NY 11226-7359
(561) 827-0372
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
933767
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
933767
CDR
NY
Enumeration date
05/04/2007
Last updated
03/25/2022
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