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NPI Code Detail

MEDICARE: MRS. JILLIAN LEE FOLEY RD,LDN

MEDICARE: MRS. JILLIAN LEE FOLEY RD,LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDN005263PA

General Provider Information

NPI Number : 1205267515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILLIAN LEE FOLEY RD,LDN
Provider Business Mailing Address
First Line : 3600 GRANT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-2630
Country : US
Telephone Number : 215-677-0400
Fax Number :
Provider Business Practice Location Address
First Line : 3600 GRANT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-2630
Country : US
Telephone Number : 215-677-0400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 12/12/2013

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