Provider Demographics
NPI:1538311337
Name:CROMWELL, JENNIFER L (RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 HENDRICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3241
Mailing Address - Country:US
Mailing Address - Phone:716-523-3864
Mailing Address - Fax:
Practice Address - Street 1:206 S ELMWOOD AVE
Practice Address - Street 2:AIDS COMMUNITY SERVICES
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2398
Practice Address - Country:US
Practice Address - Phone:716-847-0328
Practice Address - Fax:716-847-2715
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005329-1133N00000X
NY810734133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356390918Medicaid