Provider Demographics
NPI:1497068738
Name:JARRY, DEBORAH C (CDN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:C
Last Name:JARRY
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 ROUTE 216
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5620
Mailing Address - Country:US
Mailing Address - Phone:845-518-2164
Mailing Address - Fax:845-478-2069
Practice Address - Street 1:8 DYCKMAN DR
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1851
Practice Address - Country:US
Practice Address - Phone:914-526-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004204-1133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education