Healthcare Provider Details

I. General information

NPI: 1023750668
Provider Name (Legal Business Name): LORI B KANTER D.P. M, R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MICHAELS LN
GLEN HEAD NY
11545-2015
US

IV. Provider business mailing address

4 MICHAELS LN
GLEN HEAD NY
11545-2015
US

V. Phone/Fax

Practice location:
  • Phone: 516-671-9052
  • Fax:
Mailing address:
  • Phone: 516-671-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number007647-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004105-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: