Provider Demographics
NPI:1235530544
Name:FARRO, JORGE (RD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:FARRO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3813
Mailing Address - Country:US
Mailing Address - Phone:760-845-8724
Mailing Address - Fax:
Practice Address - Street 1:4 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3813
Practice Address - Country:US
Practice Address - Phone:760-845-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-07
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered