Healthcare Provider Details

I. General information

NPI: 1285727073
Provider Name (Legal Business Name): KATHLEEN FULGIONE RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN MORAN RDN

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CONKLIN AVE
TAPPAN NY
10983-2004
US

IV. Provider business mailing address

61 CONKLIN AVE
TAPPAN NY
10983-2004
US

V. Phone/Fax

Practice location:
  • Phone: 845-535-1725
  • Fax:
Mailing address:
  • Phone: 845-535-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number002870-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: