Individual provider Active NPI

Karen J Kelly, RD

  • Registered Dietitian
  • Hoboken, NJ
National Provider Identifier
1679731301
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
883338 Issued in NJ
Practice address
613 Bloomfield St
# 3
Hoboken, NJ 07030-4912
Phone
(201) 264-4065
NPI assigned
May 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 883338 NJ Primary

Addresses

Primary practice location

613 Bloomfield St
# 3
Hoboken, NJ 07030-4912

Mailing address

613 Bloomfield St
# 3
Hoboken, NJ 07030-4912
Phone (201) 264-4065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040115000277 NJ Practitioner - Registered Dietitian Or Nutrition Professional 0345141214 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
883338NJMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Laparoscopic Edge, PC CurrentSince Jun 1, 2014 Accepting new patients

Locations

79 Hudson St
Ste 301
Hoboken, NJ 07030
Phone (908) 481-1270

193 Morris Ave
#2
Springfield, NJ 07081
Phone (201) 456-5657

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212019200000",
    "number": "1679731301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 BLOOMFIELD ST",
            "address_2": "# 3",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070304912",
            "telephone_number": "201-264-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 BLOOMFIELD ST",
            "address_2": "# 3",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070304912",
            "telephone_number": "201-264-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KAREN",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NJ",
            "license": "883338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoboken, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.