Provider Demographics
NPI:1891554325
Name:ABRAM, JENICA KOWLOWITZ (MPH, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:KOWLOWITZ
Last Name:ABRAM
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2211
Mailing Address - Country:US
Mailing Address - Phone:781-879-4061
Mailing Address - Fax:
Practice Address - Street 1:551 ELM ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2211
Practice Address - Country:US
Practice Address - Phone:781-879-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered