Provider Demographics
NPI:1063840098
Name:MORAN, CAITLIN (RD, RN, CDE)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:RD, RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WATER ST
Mailing Address - Street 2:19TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:646-458-6511
Mailing Address - Fax:212-323-3103
Practice Address - Street 1:160 WATER ST
Practice Address - Street 2:19TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4922
Practice Address - Country:US
Practice Address - Phone:646-458-6511
Practice Address - Fax:212-323-3103
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered