Provider Demographics
NPI:1174763106
Name:SOCOL, ROBYN RACHEL (RD)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:RACHEL
Last Name:SOCOL
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 1:14419 72ND DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2403
Mailing Address - Country:US
Mailing Address - Phone:917-750-1107
Mailing Address - Fax:
Practice Address - Street 1:14419 72ND DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2403
Practice Address - Country:US
Practice Address - Phone:917-750-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY807413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered