Provider Demographics
NPI:1417714189
Name:SIMONE, JENNIFER LELLA (RDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LELLA
Last Name:SIMONE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JAMES CT
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3048
Mailing Address - Country:US
Mailing Address - Phone:973-879-5689
Mailing Address - Fax:
Practice Address - Street 1:16 JAMES CT
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3048
Practice Address - Country:US
Practice Address - Phone:973-879-5689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ837718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered