Provider Demographics
NPI:1659985307
Name:BALONE, KATHRYN (RD, CDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BALONE
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HENRY ST APT C
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5809
Mailing Address - Country:US
Mailing Address - Phone:716-208-4306
Mailing Address - Fax:
Practice Address - Street 1:23 HENRY ST APT C
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5809
Practice Address - Country:US
Practice Address - Phone:716-208-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007185133V00000X
1036587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered