Active NPI
Kathy L Anderson, R.D. MS, CDN, MBA
- Registered Dietitian
- Bronx, NY
National Provider Identifier
1154763233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 719830
- Practice address
- 2504 Olinville Ave
Apt 1G
Bronx, NY 10467-7452 - Phone
- (646) 261-7091
- Fax
- (914) 293-2661
- NPI assigned
- Jul 18, 2013
- Last updated
- May 4, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 719830 | NY | Primary |
Addresses
Primary practice location
2504 Olinville Ave
Apt 1G
Bronx, NY 10467-7452
Mailing address
2504 Olinville Ave
Apt 1G
Bronx, NY 10467-7452
Phone (646) 261-7091
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001798 | Other | NY | CD/N CERTIFIED DIETITIAN NUTRITIONIST UNIVERSITY OF THE STATE OF NEW YORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 719830 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430697600000",
"number": "1154763233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2504 OLINVILLE AVE",
"address_2": "APT 1G",
"city": "BRONX",
"state": "NY",
"postal_code": "104677452",
"telephone_number": "646-261-7091",
"fax_number": "914-293-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2504 OLINVILLE AVE",
"address_2": "APT 1G",
"city": "BRONX",
"state": "NY",
"postal_code": "104677452",
"telephone_number": "646-261-7091",
"fax_number": "914-293-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "KATHY",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "R.D. MS, CDN, MBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-18",
"last_updated": "2015-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "719830",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CD/N CERTIFIED DIETITIAN NUTRITIONIST UNIVERSITY OF THE STATE OF NEW YORK",
"identifier": "001798",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.