Healthcare Provider Details

I. General information

NPI: 1699009662
Provider Name (Legal Business Name): LESASH NUTRITION & HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 SKYLINE DR
STATEN ISLAND NY
10304-4770
US

IV. Provider business mailing address

PO BOX 320648
BROOKLYN NY
11232-0648
US

V. Phone/Fax

Practice location:
  • Phone: 347-242-9804
  • Fax: 718-981-4580
Mailing address:
  • Phone: 347-242-9804
  • Fax: 718-981-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number003629-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003629-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number003629-1
License Number StateNY

VIII. Authorized Official

Name: MS. JENNILYN JACKMAN BAPTISTE
Title or Position: OWNER
Credential: RD, CDN
Phone: 347-242-9804