Provider Demographics
NPI:1689429649
Name:SCHOONDERWOERD, JASON CHRISTOPHER (PENG)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:SCHOONDERWOERD
Suffix:
Gender:M
Credentials:PENG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 MONROE AVE APT 29
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1226
Mailing Address - Country:US
Mailing Address - Phone:585-255-0210
Mailing Address - Fax:
Practice Address - Street 1:3660 MONROE AVE APT 29
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1226
Practice Address - Country:US
Practice Address - Phone:585-255-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist