Provider Demographics
NPI:1740745165
Name:ZORN, KERRY (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:
Last Name:ZORN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 SUNRISE HWY FL 1
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:733 SUNRISE HWY FL 1
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2910
Practice Address - Country:US
Practice Address - Phone:516-593-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
808666133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered