Provider Demographics
NPI:1255044319
Name:GAFFNEY, KATHLEEN (RD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GAFFNEY
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 1:48 MACON DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1466
Mailing Address - Country:US
Mailing Address - Phone:908-397-7335
Mailing Address - Fax:
Practice Address - Street 1:48 MACON DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1466
Practice Address - Country:US
Practice Address - Phone:908-397-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86065046133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ86065046OtherCOMMISSION ON DIETETIC REGISTRATION I.D. NUMBER