Provider Demographics
NPI:1285727073
Name:FULGIONE, KATHLEEN (RDN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:FULGIONE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:61 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2004
Mailing Address - Country:US
Mailing Address - Phone:845-535-1725
Mailing Address - Fax:
Practice Address - Street 1:61 CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2004
Practice Address - Country:US
Practice Address - Phone:845-535-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002870-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered