Healthcare Provider Details

I. General information

NPI: 1821517475
Provider Name (Legal Business Name): LORRAINE ANN KEARNEY RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 5TH AVE STE K254
NEW YORK NY
10001-7604
US

IV. Provider business mailing address

244 5TH AVE STE K254
NEW YORK NY
10001-7604
US

V. Phone/Fax

Practice location:
  • Phone: 917-770-5124
  • Fax:
Mailing address:
  • Phone: 917-770-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86016370
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number86016370
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86016370
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86016370
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number86016370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: