Provider Demographics
NPI:1730364514
Name:PILGRIM, IRIS T
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:T
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17114 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2244
Mailing Address - Country:US
Mailing Address - Phone:718-527-1837
Mailing Address - Fax:
Practice Address - Street 1:17114 119TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2244
Practice Address - Country:US
Practice Address - Phone:718-527-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education