Organization
JENNIFER STACK DIETITIAN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER STACK RD (OWNER/RD)
(917) 370-7888
Entity
Organization
Contact information
Practice address
122 MAIN ST, NEW PALTZ, NY 12561
(917) 370-7888
Mailing address
PO BOX 374, GARDINER, NY 12525-0374
(917) 370-7888
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841783636
INDIVIDUAL NPI
—
Enumeration date
06/26/2018
Last updated
07/18/2018
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