Provider Demographics
NPI:1528368529
Name:RICHARDSON, BARBARA A (RD)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 BAINBRIDGE AVE
Mailing Address - Street 2:2G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2803
Mailing Address - Country:US
Mailing Address - Phone:347-597-6496
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-8724
Practice Address - Fax:718-901-8676
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL718281133V00000X
NY002374-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered