Provider Demographics
NPI:1497173132
Name:CIPULLO, LAURA (RD, CDE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CIPULLO
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 UNIVERSITY PL
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4564
Mailing Address - Country:US
Mailing Address - Phone:917-572-7137
Mailing Address - Fax:
Practice Address - Street 1:80 UNIVERSITY PL
Practice Address - Street 2:SUITE 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4564
Practice Address - Country:US
Practice Address - Phone:917-572-7137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48 005240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered