Healthcare Provider Details

I. General information

NPI: 1710145834
Provider Name (Legal Business Name): KATHERINE S. IPPOLITO RD, CDE, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOLISANO CHILDRENS HOSPITAL 601 ELMWOOD AVE BOX 777
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

40 SCHOOLHOUSE LN
ROCHESTER NY
14618-3232
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1539
  • Fax: 585-244-6097
Mailing address:
  • Phone: 585-461-3743
  • Fax: 585-244-6097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number001930-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: