Healthcare Provider Details

I. General information

NPI: 1013537034
Provider Name (Legal Business Name): LEAH MARK INTEGRATIVE NUTRITION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GREEN ST STE 2
HUNTINGTON NY
11743-3393
US

IV. Provider business mailing address

44 GREEN ST
HUNTINGTON NY
11743-3393
US

V. Phone/Fax

Practice location:
  • Phone: 516-806-0045
  • Fax: 516-861-0061
Mailing address:
  • Phone: 516-200-1902
  • Fax: 516-861-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LEAH MARK
Title or Position: OWNER
Credential: RD
Phone: 516-810-8808