Active NPI
Jaclyn S Tane, RD
- Nutritionist
- Roslyn Heights, NY
National Provider Identifier
1063726347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 006416
- Practice address
- 216 Willis Ave
Ste 001
Roslyn Heights, NY 11577-2125 - Phone
- (516) 801-0022
- Fax
- (516) 277-1533
- NPI assigned
- Jul 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 006416 | NY | Primary |
Addresses
Primary practice location
216 Willis Ave
Ste 001
Roslyn Heights, NY 11577-2125
Mailing address
216 Willis Ave
Ste 001
Roslyn Heights, NY 11577-2125
Phone (516) 801-0022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006416 | NY | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314921600000",
"number": "1063726347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 WILLIS AVE",
"address_2": "STE 001",
"city": "ROSLYN HEIGHTS",
"state": "NY",
"postal_code": "115772125",
"telephone_number": "516-801-0022",
"fax_number": "516-277-1533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 WILLIS AVE",
"address_2": "STE 001",
"city": "ROSLYN HEIGHTS",
"state": "NY",
"postal_code": "115772125",
"telephone_number": "516-801-0022",
"fax_number": "516-277-1533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANE",
"first_name": "JACLYN",
"middle_name": "S",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-29",
"last_updated": "2011-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "NY",
"license": "006416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roslyn Heights, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.