Provider Demographics
NPI:1265480610
Name:DEPAOLO, JENNIFER ANNE (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:DEPAOLO
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:GRAMATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:145 HICKS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2321
Mailing Address - Country:US
Mailing Address - Phone:917-447-6135
Mailing Address - Fax:
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 1414
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-333-4243
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005504-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7791422OtherAETNA
NY8099852OtherGHI
NY1G1071OtherBLUECROSS
NY3C6153OtherHEALTHNET
NY7762747003OtherCIGNA
NYDJ5504OtherATLANTIS
NY3096578OtherUSHC
NY005504OtherHIP PROV #
NY10765267OtherHIP PIN#
NY2281535OtherUNITED
NYP2793985OtherOXFORD
NY116230POtherHIP PRIS#