Provider Demographics
NPI:1710083498
Name:HYMAN, JENNIFER LOUISE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:HYMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LOUISE
Other - Last Name:FEINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5 WILLIAMS BLVD APT 2C
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2484
Mailing Address - Country:US
Mailing Address - Phone:631-285-1784
Mailing Address - Fax:
Practice Address - Street 1:82 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4411
Practice Address - Country:US
Practice Address - Phone:631-854-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY925844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ40659Medicare UPIN
NY9406E1Medicare ID - Type Unspecified