Healthcare Provider Details

I. General information

NPI: 1053732610
Provider Name (Legal Business Name): JESSICA LYNN CAHILL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LACONTORA RD

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W CRYSTAL LAKE AVE
HADDONFIELD NJ
08033-2806
US

IV. Provider business mailing address

30 LINDIS FARNE AVE
HADDON TOWNSHIP NJ
08108-2736
US

V. Phone/Fax

Practice location:
  • Phone: 609-472-1339
  • Fax:
Mailing address:
  • Phone: 856-912-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1099681
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: