Provider Demographics
NPI:1609588367
Name:DWORKIN, JILL ERIKA (BCHN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ERIKA
Last Name:DWORKIN
Suffix:
Gender:F
Credentials:BCHN
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:DWORKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCHN
Mailing Address - Street 1:314 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4153
Mailing Address - Country:US
Mailing Address - Phone:202-270-5612
Mailing Address - Fax:
Practice Address - Street 1:314 CHESTNUT HILL RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4153
Practice Address - Country:US
Practice Address - Phone:202-270-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MCC8099OtherMERCHANT CATEGORY CLASSIFICATION CODE