Provider Demographics
NPI:1972527042
Name:PURCELL, PAM R (MSRD, CNSD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:R
Last Name:PURCELL
Suffix:
Gender:F
Credentials:MSRD, CNSD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:16 WILLOW RD
Mailing Address - City:LINCOLNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10540-0184
Mailing Address - Country:US
Mailing Address - Phone:701-584-9000
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:JAMES J PETERS VETERAN AFFAIRS MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10548
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered