Active NPI
Jean Marie Anderson, RD, CDN,CDE,MS
- Registered Dietitian
- Northport, NY
National Provider Identifier
1750475315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 805573
- Practice address
- 79 Middleville Rd
Northport, NY 11768-2200 - Phone
- (631) 261-4400
- Fax
- (631) 266-6018
- NPI assigned
- Oct 3, 2006
- Last updated
- Nov 6, 2009
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 805573 | Primary |
Addresses
Primary practice location
79 Middleville Rd
Northport, NY 11768-2200
Mailing address
79 Middleville Rd
Northport, NY 11768-2200
Phone (631) 261-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000570-1 | Other | NY | CERTIFIED DIETITIAN-NUTRI |
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257465600000",
"number": "1750475315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 MIDDLEVILLE RD",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117682200",
"telephone_number": "631-261-4400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 MIDDLEVILLE RD",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117682200",
"telephone_number": "631-261-4400",
"fax_number": "631-266-6018"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JEAN",
"middle_name": "MARIE",
"credential": "RD, CDN,CDE,MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2009-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "805573",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED DIETITIAN-NUTRI",
"identifier": "000570-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.