Provider Demographics
NPI:1346309978
Name:DETROYER, MARY JANE (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:DETROYER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 E 57TH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2907
Mailing Address - Country:US
Mailing Address - Phone:212-759-7110
Mailing Address - Fax:212-759-7113
Practice Address - Street 1:357 E 57TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2907
Practice Address - Country:US
Practice Address - Phone:212-759-7110
Practice Address - Fax:212-759-7113
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004019-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered