Healthcare Provider Details

I. General information

NPI: 1750983995
Provider Name (Legal Business Name): LGC NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 ADAMS ST
DELMAR NY
12054-3211
US

IV. Provider business mailing address

679 NEW SALEM RD
VOORHEESVILLE NY
12186-4832
US

V. Phone/Fax

Practice location:
  • Phone: 518-470-0866
  • Fax:
Mailing address:
  • Phone: 518-470-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY G CUMOLETTI
Title or Position: REGISTERED DIETITIAN/OWNER
Credential: RD
Phone: 518-470-0866