Provider Demographics
NPI:1801930987
Name:JAKALOW, DEBRA (MS, RD, APRN, CDE)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:JAKALOW
Suffix:
Gender:F
Credentials:MS, RD, APRN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BREWERY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6115
Mailing Address - Country:US
Mailing Address - Phone:845-638-2060
Mailing Address - Fax:845-638-2807
Practice Address - Street 1:5 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-362-3111
Practice Address - Fax:845-362-3198
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000344-1133V00000X
NY454993163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator