Provider Demographics
NPI:1629448097
Name:DAY, KATHLEEN I
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DAY
Suffix:I
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 1:542 4TH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2146
Mailing Address - Country:US
Mailing Address - Phone:201-390-3861
Mailing Address - Fax:201-383-0097
Practice Address - Street 1:297 KINDERKAMACK RD STE 202
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1535
Practice Address - Country:US
Practice Address - Phone:201-390-3861
Practice Address - Fax:201-383-0097
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1019678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered