Provider Demographics
NPI:1629212170
Name:RICHARDS, LYDIA ROSETTA (CDN PD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ROSETTA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CDN PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3824
Mailing Address - Country:US
Mailing Address - Phone:212-663-0473
Mailing Address - Fax:
Practice Address - Street 1:49 W 127TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3824
Practice Address - Country:US
Practice Address - Phone:212-663-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003082133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist