Provider Demographics
NPI:1447268206
Name:JASKIEWICZ, JULIA (RD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JASKIEWICZ
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 1:8 MOUNTAINSIDE PARK TER
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1209
Mailing Address - Country:US
Mailing Address - Phone:973-509-8879
Mailing Address - Fax:973-655-0622
Practice Address - Street 1:8 MOUNTAINSIDE PARK TER
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1209
Practice Address - Country:US
Practice Address - Phone:973-509-8879
Practice Address - Fax:973-655-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ723799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063619Medicare ID - Type Unspecified