Individual
KATHERINE VINCENZA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN
Contact information
Practice address
251 N TITMUS DR, MASTIC, NY 11950-1515
(631) 377-1793
Mailing address
251 N TITMUS DR, MASTIC, NY 11950-1515
(631) 377-1793
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86392502
NY
Other
Enumeration date
04/16/2026
Last updated
04/16/2026
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