Healthcare Provider Details

I. General information

NPI: 1538311337
Provider Name (Legal Business Name): JENNIFER L CROMWELL RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S ELMWOOD AVE AIDS COMMUNITY SERVICES
BUFFALO NY
14201-2398
US

IV. Provider business mailing address

147 HENDRICKS BLVD
AMHERST NY
14226-3241
US

V. Phone/Fax

Practice location:
  • Phone: 716-847-0328
  • Fax: 716-847-2715
Mailing address:
  • Phone: 716-523-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number005329-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number810734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: