Provider Demographics
NPI:1043452428
Name:BLANCHARD, CAROL JEAN (MBA, RD, CDN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MBA, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DOWNING ST
Mailing Address - Street 2:9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4747
Mailing Address - Country:US
Mailing Address - Phone:646-306-6275
Mailing Address - Fax:
Practice Address - Street 1:13 DOWNING ST
Practice Address - Street 2:9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4747
Practice Address - Country:US
Practice Address - Phone:646-306-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006680-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered