Healthcare Provider Details

I. General information

NPI: 1598524258
Provider Name (Legal Business Name): LYSSA BROOKE LAMPORT MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 ESSEX CT
PORT WASHINGTON NY
11050-4221
US

IV. Provider business mailing address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

V. Phone/Fax

Practice location:
  • Phone: 917-656-2110
  • Fax:
Mailing address:
  • Phone: 718-470-3195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number011685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: