Healthcare Provider Details

I. General information

NPI: 1003867920
Provider Name (Legal Business Name): JENNIFER ELIZABETH FILLER RD, CD-N, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLOUGHBY ST SUITE 11E
BROOKLYN NY
11201-5465
US

IV. Provider business mailing address

496 1/2 6TH AVE
BROOKLYN NY
11215-4905
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8866
  • Fax: 718-250-6705
Mailing address:
  • Phone: 631-766-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number006101-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: