Provider Demographics
NPI:1326308131
Name:AIZEN, JACQUELINE (RD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:AIZEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 174TH ST APT 1112
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3340
Mailing Address - Country:US
Mailing Address - Phone:646-623-0399
Mailing Address - Fax:
Practice Address - Street 1:210 174TH ST FL 33160
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3329
Practice Address - Country:US
Practice Address - Phone:646-623-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY997860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered