Provider Demographics
NPI:1407491772
Name:ANDREACCHIO, KIMBERLY (RD, CDN, CDE)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ANDREACCHIO
Suffix:
Gender:F
Credentials:RD, CDN, CDE
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PHILBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:885 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1836
Mailing Address - Country:US
Mailing Address - Phone:516-376-7057
Mailing Address - Fax:
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-472-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management