Healthcare Provider Details

I. General information

NPI: 1407491772
Provider Name (Legal Business Name): KIMBERLY ANDREACCHIO RD, CDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY PHILBIN RD, CDN

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE
NEW HYDE PARK NY
11042-2057
US

IV. Provider business mailing address

885 THIRD AVE
FRANKLIN SQUARE NY
11010-1836
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3716
  • Fax:
Mailing address:
  • Phone: 516-376-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: