Provider Demographics
NPI:1568959633
Name:KOROLY, JENNA ANN (MS, RD, CSOWM, CDN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:KOROLY
Suffix:
Gender:F
Credentials:MS, RD, CSOWM, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 50TH AVE APT 510W
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5935
Mailing Address - Country:US
Mailing Address - Phone:914-274-0843
Mailing Address - Fax:
Practice Address - Street 1:186 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2822
Practice Address - Country:US
Practice Address - Phone:212-434-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4857133V00000X
NY86073589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered