Individual
JEAN MARIE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDN,CDE,MS
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
(631) 266-6018
Mailing address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
805573
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000570-1
CERTIFIED DIETITIAN-NUTRI
NY
Enumeration date
10/03/2006
Last updated
11/06/2009
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