Provider Demographics
NPI:1710145834
Name:IPPOLITO, KATHERINE S (RD, CDE, CDN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:S
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:RD, CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3232
Mailing Address - Country:US
Mailing Address - Phone:585-461-3743
Mailing Address - Fax:585-244-6097
Practice Address - Street 1:GOLISANO CHILDRENS HOSPITAL 601 ELMWOOD AVE
Practice Address - Street 2:BOX 777
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-1539
Practice Address - Fax:585-244-6097
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001930-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered