Jaclyn Danielle Leet, RDN is a medicare enrolled "Dietitian, Registered" provider in Bloomingdale, New Jersey. Her current practice location is
42 Chestnut St, Bloomingdale, New Jersey. You can reach out to her office (for appointments etc.) via phone at
(973) 919-7330.
Jaclyn Danielle Leet is licensed to practice in New Jersey (license number 86083824) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1013462993.
Healthcare Provider's Profile
| Full Name | Jaclyn Danielle Leet |
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| Gender | Female |
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| Speciality | Dietitian, Registered |
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| Location | 42 Chestnut St, Bloomingdale, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1013462993
- Provider Enumeration Date: 08/19/2016
- Last Update Date: 10/18/2022
Medicare PECOS Information:
- PECOS PAC ID: 2466896923
- Enrollment ID: I20240223000378
Medical Identifiers
Medical identifiers for Jaclyn Danielle Leet such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1013462993 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | 86083824 (New Jersey) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jaclyn Danielle Leet allows following entities to bill medicare on her behalf.
| Provider Name | Nourish, Inc. |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1558097824
PECOS PAC ID: 1557724937
Enrollment ID: O20230901000471 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jaclyn Danielle Leet is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jaclyn Danielle Leet, RDN
5 Brotherton Ave,
Rockaway, NJ 07866-4801
Ph: (973) 919-7330 | Jaclyn Danielle Leet, RDN
42 Chestnut St,
Bloomingdale, NJ 07403-1729
Ph: (973) 919-7330 |
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