Provider Demographics
NPI:1831583509
Name:DURKAN, AMY (RDN, CDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DURKAN
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:PETTIBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CDN
Mailing Address - Street 1:200 W 54TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:SOUTH HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07606-1903
Practice Address - Country:US
Practice Address - Phone:201-880-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
996506133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered