Provider Demographics
NPI:1194231134
Name:CARDILLO, KRISTIN (RD, CDN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CARDILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:ADVANTAGECARE PHYSICIANS PC
Mailing Address - Street 2:55 WATER STREET, 2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0010
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:1050 CLOVE ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301
Practice Address - Country:US
Practice Address - Phone:718-816-6440
Practice Address - Fax:718-420-2718
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009243-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered