Provider Demographics
NPI:1720025026
Name:DARBY, PAMELA (RD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 74TH ST
Mailing Address - Street 2:#2L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3353
Mailing Address - Country:US
Mailing Address - Phone:917-546-6636
Mailing Address - Fax:917-546-6655
Practice Address - Street 1:225 E 74TH ST
Practice Address - Street 2:#2L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3353
Practice Address - Country:US
Practice Address - Phone:917-546-6636
Practice Address - Fax:917-546-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476792420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered