Provider Demographics
NPI:1780055525
Name:ABDALLAH, JILL M (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:ABDALLAH
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 1:1 GREENACRES LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2705
Mailing Address - Country:US
Mailing Address - Phone:914-345-0719
Mailing Address - Fax:914-345-0720
Practice Address - Street 1:1 GREENACRES LN
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-2705
Practice Address - Country:US
Practice Address - Phone:914-345-0719
Practice Address - Fax:914-345-0720
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007913-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered