1154763233 NPI number — MS. KATHY L ANDERSON R.D. MS, CDN, MBA

Table of content: MS. KATHY L ANDERSON R.D. MS, CDN, MBA (NPI 1154763233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154763233 NPI number — MS. KATHY L ANDERSON R.D. MS, CDN, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
KATHY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D. MS, CDN, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154763233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2504 OLINVILLE AVE
Provider Second Line Business Mailing Address:
APT 1G
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10467-7452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-261-7091
Provider Business Mailing Address Fax Number:
914-293-2661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2504 OLINVILLE AVE
Provider Second Line Business Practice Location Address:
APT 1G
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-7452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-261-7091
Provider Business Practice Location Address Fax Number:
914-293-2661
Provider Enumeration Date:
07/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  719830 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001798 . This is a "CD/N CERTIFIED DIETITIAN NUTRITIONIST UNIVERSITY OF THE STATE OF NEW YORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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