Provider Demographics
NPI:1043664568
Name:CRISCITELLI, KRISTEN (RD, CDN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CRISCITELLI
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:SOTTILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:21208 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1525
Mailing Address - Country:US
Mailing Address - Phone:516-353-9873
Mailing Address - Fax:
Practice Address - Street 1:29 GUION PLACE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-365-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8344060133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered