Provider Demographics
NPI:1568707958
Name:BLOCKER, ROBIN OLIVIA (RD, MA, IBCLC, CLC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:OLIVIA
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:RD, MA, IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6006
Mailing Address - Country:US
Mailing Address - Phone:631-747-3357
Mailing Address - Fax:
Practice Address - Street 1:22 FRANK ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-6006
Practice Address - Country:US
Practice Address - Phone:631-747-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered