Provider Demographics
NPI:1508442609
Name:ABRAMS, JESSICA (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RITA CRES
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5217
Mailing Address - Country:US
Mailing Address - Phone:917-502-7131
Mailing Address - Fax:
Practice Address - Street 1:9 RITA CRES
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5217
Practice Address - Country:US
Practice Address - Phone:917-502-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86042641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered