=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386768216
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL SCHAEFFER RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2322 30TH AVE SUITE B
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11102-3255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-267-2763
-----------------------------------------------------
Fax | 718-267-2936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11250 78TH AVE #1-O
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-7109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-263-9555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 005414-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------