Provider Demographics
NPI:1922348853
Name:MCKITTRICK, MARTHA TAYLOR (RD, CDE, CDN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:TAYLOR
Last Name:MCKITTRICK
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 1:201 E 66TH ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6454
Mailing Address - Country:US
Mailing Address - Phone:212-879-5167
Mailing Address - Fax:
Practice Address - Street 1:30 CENTRAL PARK S RM 13A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1654
Practice Address - Country:US
Practice Address - Phone:212-879-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered