Provider Demographics
NPI:1770816423
Name:LONDON, HAILEY PAIGE (RD)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:PAIGE
Last Name:LONDON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RICHARDSON ST
Mailing Address - Street 2:#1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1208
Mailing Address - Country:US
Mailing Address - Phone:201-745-3033
Mailing Address - Fax:
Practice Address - Street 1:24 RICHARDSON ST
Practice Address - Street 2:#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1208
Practice Address - Country:US
Practice Address - Phone:201-745-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
865271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY865271OtherCDR