Provider Demographics
NPI:1912769019
Name:IPPOLITO, KATHERINE ANNA (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNA
Last Name:IPPOLITO
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 1:271 METROPOLITAN AVE APT 3I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4008
Mailing Address - Country:US
Mailing Address - Phone:914-261-5365
Mailing Address - Fax:
Practice Address - Street 1:271 METROPOLITAN AVE APT 3I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4008
Practice Address - Country:US
Practice Address - Phone:914-261-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86288624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered