Provider Demographics
NPI:1487449112
Name:FRANTZEN, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:FRANTZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQ
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1628
Mailing Address - Country:US
Mailing Address - Phone:516-567-0107
Mailing Address - Fax:
Practice Address - Street 1:290 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQ
Practice Address - State:NY
Practice Address - Zip Code:11010-1628
Practice Address - Country:US
Practice Address - Phone:516-567-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered