Healthcare Provider Details

I. General information

NPI: 1154845881
Provider Name (Legal Business Name): JILL MEGAN ALTIMARE LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 3RD ST FL 2
EASTON PA
18042-1869
US

IV. Provider business mailing address

100 N 3RD ST FL 2
EASTON PA
18042-1869
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-8010
  • Fax: 484-503-8009
Mailing address:
  • Phone: 484-503-8010
  • Fax: 484-503-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: