Provider Demographics
NPI:1558526855
Name:VERGILI, JOYCE MARCLEY (EDD, RD, CDE)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:MARCLEY
Last Name:VERGILI
Suffix:
Gender:F
Credentials:EDD, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DENVER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1102
Mailing Address - Country:US
Mailing Address - Phone:845-339-6334
Mailing Address - Fax:845-339-6334
Practice Address - Street 1:34 DENVER RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1102
Practice Address - Country:US
Practice Address - Phone:845-339-6334
Practice Address - Fax:845-339-6334
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000805-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS00671Medicare PIN