Provider Demographics
NPI:1770780082
Name:POPADIN, DARLENE (PT)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:
Last Name:POPADIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 BAKER PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-3005
Mailing Address - Country:US
Mailing Address - Phone:718-273-4456
Mailing Address - Fax:
Practice Address - Street 1:178 MORRISON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2835
Practice Address - Country:US
Practice Address - Phone:718-442-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010922-1320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities