Provider Demographics
NPI:1538566419
Name:PAULINE, KIM MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:PAULINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S MAPLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2137
Mailing Address - Country:US
Mailing Address - Phone:315-383-7862
Mailing Address - Fax:866-475-1097
Practice Address - Street 1:8 S MAPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2137
Practice Address - Country:US
Practice Address - Phone:315-383-7862
Practice Address - Fax:866-475-1097
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education