Provider Demographics
NPI:1366853962
Name:MCKEOWN, BRIDGET (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E 57TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3097
Mailing Address - Country:US
Mailing Address - Phone:610-550-9169
Mailing Address - Fax:
Practice Address - Street 1:261 E 78TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1216
Practice Address - Country:US
Practice Address - Phone:610-550-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008120-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered