Provider Demographics
NPI:1184839003
Name:KEVIN L CINTRON RD LLC
Entity Type:Organization
Organization Name:KEVIN L CINTRON RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST DIETITIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:718-684-2542
Mailing Address - Street 1:350 W 24TH ST
Mailing Address - Street 2:APT 12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2246
Mailing Address - Country:US
Mailing Address - Phone:718-684-2542
Mailing Address - Fax:718-684-2726
Practice Address - Street 1:1545 HAIGHT AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-684-2542
Practice Address - Fax:718-684-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024441133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS01861Medicare ID - Type Unspecified
P45162Medicare UPIN