Active NPI
Kim Manfried, R.D.
- Registered Dietitian
- Hicksville, NY
National Provider Identifier
1205136934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 400 South Oyster Road
Suite 300
Hicksville, NY 11801-1180 - Phone
- (631) 203-8133
- Fax
- (833) 734-1553
- NPI assigned
- Oct 28, 2010
- 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 | Primary |
Addresses
Primary practice location
400 South Oyster Road
Suite 300
Hicksville, NY 11801-1180
Mailing address
30 Walter CT
Commack, NY 11725-3602
Phone (631) 852-1000
Other practice location 1
550 Montauk Hwy
Shirley, NY 11967-2114
Phone (631) 852-1000
Other practice location 2
358 Veterans Memorial Hwy Ste 10
Commack, NY 11725-4326
Phone (631) 203-8133
Other practice location 3
200 Broadhollow Rd Ste 207
Melville, NY 11747-4806
Phone (631) 203-8133
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1205136934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 WALTER CT",
"city": "COMMACK",
"state": "NY",
"postal_code": "117253602",
"telephone_number": "631-852-1000",
"fax_number": "833-734-1553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 SOUTH OYSTER ROAD",
"address_2": "SUITE 300",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118011180",
"telephone_number": "631-203-8133",
"fax_number": "833-734-1553"
}
],
"practiceLocations": [
{
"address_1": "550 Montauk Hwy",
"address_purpose": "LOCATION",
"city": "Shirley",
"state": "NY",
"postal_code": "119672114",
"country_code": "US",
"telephone_number": "631-852-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "358 Veterans Memorial Hwy Ste 10",
"address_purpose": "LOCATION",
"city": "Commack",
"state": "NY",
"postal_code": "117254326",
"country_code": "US",
"telephone_number": "631-203-8133",
"fax_number": "833-734-1553",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "200 Broadhollow Rd Ste 207",
"address_purpose": "LOCATION",
"city": "Melville",
"state": "NY",
"postal_code": "117474806",
"country_code": "US",
"telephone_number": "631-203-8133",
"fax_number": "833-734-1553",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MANFRIED",
"first_name": "KIM",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-28",
"last_updated": "2021-05-24",
"certification_date": "2021-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hicksville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.