Healthcare Provider Details

I. General information

NPI: 1508442609
Provider Name (Legal Business Name): JESSICA ABRAMS MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RITA CRES
COMMACK NY
11725-5217
US

IV. Provider business mailing address

9 RITA CRES
COMMACK NY
11725-5217
US

V. Phone/Fax

Practice location:
  • Phone: 917-502-7131
  • Fax:
Mailing address:
  • Phone: 917-502-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86042641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: