Provider Demographics
NPI:1386768216
Name:SCHAEFFER, JILL (RD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 78TH AVE
Mailing Address - Street 2:#1-O
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7109
Mailing Address - Country:US
Mailing Address - Phone:718-263-9555
Mailing Address - Fax:
Practice Address - Street 1:2322 30TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3255
Practice Address - Country:US
Practice Address - Phone:718-267-2763
Practice Address - Fax:718-267-2936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005414-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2738994OtherOXFORD NUTRITIONIST NUMBE
NYP2754170OtherOXFORD DIETITIAN NUMBER
NYP2738994OtherOXFORD NUTRITIONIST NUMBE
NY05576Medicare ID - Type Unspecified