Provider Demographics
NPI:1386322436
Name:UDALL, JONAH (CNS, CDN)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:UDALL
Suffix:
Gender:M
Credentials:CNS, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MIDWOOD ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5025
Mailing Address - Country:US
Mailing Address - Phone:510-502-2577
Mailing Address - Fax:
Practice Address - Street 1:10 MIDWOOD ST APT 5C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5025
Practice Address - Country:US
Practice Address - Phone:510-502-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011543OtherCERTIFIED DIETETIC NUTRITIONIST