Individual provider Active NPI

Janetmarie Ennis, DTR/CDN

  • Registered Dietetic Technician
  • Rochester, NY
National Provider Identifier
1225165913
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered Dietetic TechnicianTaxonomy code 136A00000X
License
0039731 Issued in NY
Practice address
2165 Brighton Henrietta Town Line Rd
Rochester, NY 14623-2755
Phone
(585) 241-5869
Fax
(585) 241-5875
NPI assigned
Feb 28, 2007
Last updated
May 20, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietetic Technician 136A00000X 0039731 NY Primary

Addresses

Primary practice location

2165 Brighton Henrietta Town Line Rd
Rochester, NY 14623-2755

Mailing address

2165 Brighton Henrietta Town Line Rd
Rochester, NY 14623-2755
Phone (585) 241-5869

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0039731NYMDRegistered Dietetic Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1225165913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2165 BRIGHTON HENRIETTA TOWN LINE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146232755",
            "telephone_number": "585-241-5869",
            "fax_number": "585-241-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2165 BRIGHTON HENRIETTA TOWN LINE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146232755",
            "telephone_number": "585-241-5869",
            "fax_number": "585-241-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "JANETMARIE",
        "credential": "DTR/CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": "NY",
            "license": "0039731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.