Provider Demographics
NPI:1841752987
Name:CHODAK, JILL (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CHODAK
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PRINCE ST STE 3001
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1041
Mailing Address - Country:US
Mailing Address - Phone:631-375-1592
Mailing Address - Fax:
Practice Address - Street 1:46 PRINCE ST STE 3001
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1041
Practice Address - Country:US
Practice Address - Phone:631-375-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered