Provider Demographics
NPI:1497312946
Name:JALLOH, ANITA CHRISTINA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CHRISTINA
Last Name:JALLOH
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 1:120 FARM LN
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1414
Mailing Address - Country:US
Mailing Address - Phone:908-902-3910
Mailing Address - Fax:
Practice Address - Street 1:120 FARM LN
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1414
Practice Address - Country:US
Practice Address - Phone:908-902-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education