Provider Demographics
NPI:1619191632
Name:TIGUE, KATHY (RD, CDE, MPA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:TIGUE
Suffix:
Gender:F
Credentials:RD, CDE, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 S PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6817
Mailing Address - Country:US
Mailing Address - Phone:845-598-7204
Mailing Address - Fax:
Practice Address - Street 1:261 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3102
Practice Address - Country:US
Practice Address - Phone:845-598-7204
Practice Address - Fax:845-201-8319
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered