Provider Demographics
NPI:1760505028
Name:KESTING, MARYANNE B (MS,RD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:B
Last Name:KESTING
Suffix:
Gender:F
Credentials:MS,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FRANCES CT
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2718
Mailing Address - Country:US
Mailing Address - Phone:845-224-4421
Mailing Address - Fax:845-229-8860
Practice Address - Street 1:2 FRANCES CT
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2718
Practice Address - Country:US
Practice Address - Phone:845-224-4421
Practice Address - Fax:845-229-8860
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001020-1133N00000X
NY661929133V00000X
NYCDE# 0942-0370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ12357Medicare UPIN
NY925OE1Medicare ID - Type Unspecified