Provider Demographics
NPI:1114558970
Name:MORALES-THOMPSON, JONNA (MS)
Entity Type:Individual
Prefix:MRS
First Name:JONNA
Middle Name:
Last Name:MORALES-THOMPSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S BROADWAY STE B
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3133
Mailing Address - Country:US
Mailing Address - Phone:917-514-2718
Mailing Address - Fax:
Practice Address - Street 1:1 S BROADWAY STE B
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3133
Practice Address - Country:US
Practice Address - Phone:917-514-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist