Provider Demographics
NPI:1760164065
Name:ROMOLA, JESSICA (RDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROMOLA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SERDIKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:26 ROCKAWAY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9021
Mailing Address - Country:US
Mailing Address - Phone:215-915-7631
Mailing Address - Fax:
Practice Address - Street 1:26 ROCKAWAY VALLEY RD
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-9021
Practice Address - Country:US
Practice Address - Phone:215-915-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered