1003019639 NPI number — MRS. JENNIFER L FREEMAN R.D.

Table of content: MRS. JENNIFER L FREEMAN R.D. (NPI 1003019639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003019639 NPI number — MRS. JENNIFER L FREEMAN R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
JENNIFER
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003019639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 THIMBLEBERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLSTON SPA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12020-4385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-899-5445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 BURDETT AVE
Provider Second Line Business Practice Location Address:
SAMARITAN HOSPITAL - NUTRITION SERVICES
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-271-3905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  922862 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)