Provider Demographics
NPI:1649390279
Name:PFAU, JANICE K
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:K
Last Name:PFAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-2627
Mailing Address - Fax:
Practice Address - Street 1:28 BIRCH DR
Practice Address - Street 2:
Practice Address - City:DIAMOND POINT
Practice Address - State:NY
Practice Address - Zip Code:12824-1812
Practice Address - Country:US
Practice Address - Phone:518-964-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001282133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered