Active NPI
Darlene Renee Petroccione, RD, CDN
- Registered Dietitian
- Port Jefferson, NY
National Provider Identifier
1154404705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 5320-1
- Practice address
- 640 Belle Terre Rd
Building E
Port Jefferson, NY 11777-1936 - Phone
- (631) 987-4006
- Fax
- (631) 828-1138
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 5320-1 | NY | Primary |
Addresses
Primary practice location
640 Belle Terre Rd
Building E
Port Jefferson, NY 11777-1936
Mailing address
640 Belle Terre Rd
Building E
Port Jefferson, NY 11777-1936
Phone (631) 987-4006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060217000629 | NY | Practitioner - Registered Dietitian Or Nutrition Professional | 7315952975 | Practice locations: Port Jefferson, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
640 Bell Terre Rd
Port Jefferson, NY 11777-1936
Phone (631) 987-4006
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005320 | NY | MD | Mental Health Counselor |
| 5320-1 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154404705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 BELLE TERRE RD",
"address_2": "BUILDING E",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771936",
"telephone_number": "631-987-4006",
"fax_number": "631-828-1138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 BELLE TERRE RD",
"address_2": "BUILDING E",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771936",
"telephone_number": "631-987-4006",
"fax_number": "631-828-1138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROCCIONE",
"first_name": "DARLENE",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "RD, CDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "5320-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.