Provider Demographics
NPI:1316578073
Name:AMOROSO, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3921
Mailing Address - Country:US
Mailing Address - Phone:732-501-6018
Mailing Address - Fax:
Practice Address - Street 1:20 E 33RD ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3921
Practice Address - Country:US
Practice Address - Phone:732-501-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist