Healthcare Provider Details

I. General information

NPI: 1871798090
Provider Name (Legal Business Name): CAITLIN SULLIVAN KIARIE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HIGHLAND AVE
MONTCLAIR NJ
07042-1909
US

IV. Provider business mailing address

45 HIGHLAND AVE
MONTCLAIR NJ
07042-1909
US

V. Phone/Fax

Practice location:
  • Phone: 973-932-0644
  • Fax:
Mailing address:
  • Phone: 619-948-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number985191
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: