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General NPI Number Information
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NPI Number | 1407287139
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Entity Type | Individual
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Provider Name | JENNIFER ANN LLEWELLYN RD,CDE
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Gender | Female
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 6 BRIGHTON RD
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City | CLIFTON
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State | NJ
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Zip | 07012-1647
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Country | US
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Telephone | 973-471-2692
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Fax | 973-470-8188
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Provider Business Mailing Address
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Address Line | 150 FLORAL AVE
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-1557
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Country | US
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Telephone | 908-273-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 916346
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License Number State | NJ
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