Provider Demographics
NPI:1568003689
Name:DAINGERFIELD, JILL S (RD)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:S
Last Name:DAINGERFIELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:CROWLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:121 CENTER GROVE ROAD
Mailing Address - Street 2:SUITE #13
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:315-834-2382
Mailing Address - Fax:
Practice Address - Street 1:121 CENTER GROVE ROAD
Practice Address - Street 2:SUITE #13
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:315-834-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
886038133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal