Provider Demographics
NPI:1396967170
Name:MALYN, JANE TARNOFF (MA, RD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:TARNOFF
Last Name:MALYN
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W LANCASTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1592
Mailing Address - Country:US
Mailing Address - Phone:610-687-7773
Mailing Address - Fax:610-964-8870
Practice Address - Street 1:237 W LANCASTER AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1592
Practice Address - Country:US
Practice Address - Phone:610-687-7773
Practice Address - Fax:610-964-8870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000008133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered