Provider Demographics
NPI:1992257380
Name:LYNCH, JORDAN SIMONE (MS, RDN, CDN)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:SIMONE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CARROLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5210
Mailing Address - Country:US
Mailing Address - Phone:914-572-7296
Mailing Address - Fax:
Practice Address - Street 1:50 CARROLLWOOD DR
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5210
Practice Address - Country:US
Practice Address - Phone:914-572-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered