Basic Information
| Provider Information | |||||||||
| NPI: | 1124088174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | JOYCE | ||||||||
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| Credential: | RD CDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 EAST MAIN STREET | ||||||||
| Address2: | NORTHERN WESTCHESTER HOSPITAL ATTN MEDICAL AFFAIRS | ||||||||
| City: | MT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142428318 | ||||||||
| FaxNumber: | 9146661965 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 EAST MAIN STREET | ||||||||
| Address2: | NORTHERN WESTCHESTER HOSPITAL NUTRIONAL SERVICES DEPT | ||||||||
| City: | MT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661465 | ||||||||
| FaxNumber: | 9146661787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | 003813 | NY | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | 003813 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.