Provider Demographics
NPI:1760987382
Name:GORDILS, JESSICA (MMS, RDN, CDE)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GORDILS
Suffix:
Gender:F
Credentials:MMS, RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MOUNTAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1133
Mailing Address - Country:US
Mailing Address - Phone:386-871-3806
Mailing Address - Fax:
Practice Address - Street 1:36 MOUNTAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1133
Practice Address - Country:US
Practice Address - Phone:386-871-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ806140133N00000X, 133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic