Provider Demographics
NPI:1205136934
Name:MANFRIED, KIM (RD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MANFRIED
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3602
Mailing Address - Country:US
Mailing Address - Phone:631-852-1000
Mailing Address - Fax:833-734-1553
Practice Address - Street 1:400 SOUTH OYSTER ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1180
Practice Address - Country:US
Practice Address - Phone:631-203-8133
Practice Address - Fax:833-734-1553
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered