Provider Demographics
NPI:1073764635
Name:DOLPHIN, IRENE LILA (RD,CDN)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:LILA
Last Name:DOLPHIN
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 64TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6820
Mailing Address - Country:US
Mailing Address - Phone:718-821-1097
Mailing Address - Fax:
Practice Address - Street 1:27 W 23RD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4202
Practice Address - Country:US
Practice Address - Phone:347-421-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered