Provider Demographics
NPI:1003422205
Name:STARK, DANIELLE (RDN, CDN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 88TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2348
Mailing Address - Country:US
Mailing Address - Phone:973-954-0666
Mailing Address - Fax:
Practice Address - Street 1:205 W 88TH ST APT 6D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2348
Practice Address - Country:US
Practice Address - Phone:973-954-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered