Provider Demographics
NPI:1538109780
Name:EPSTEIN, IRIS R (RDCDN)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:R
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:RDCDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 ROUTE 45 STE 107
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3512
Mailing Address - Country:US
Mailing Address - Phone:845-362-1300
Mailing Address - Fax:914-352-0325
Practice Address - Street 1:978 ROUTE 45 STE 107
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3512
Practice Address - Country:US
Practice Address - Phone:845-362-1300
Practice Address - Fax:914-352-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003101-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421705Medicaid
NY03P411Medicare ID - Type Unspecified
NY01421705Medicaid