Healthcare Provider Details

I. General information

NPI: 1073630695
Provider Name (Legal Business Name): LINDA A LOTITO CDN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 RICHMOND AVE
STATEN ISLAND NY
10312
US

IV. Provider business mailing address

3705 RICHMOND AVE
STATEN ISLAND NY
10312
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-1296
  • Fax:
Mailing address:
  • Phone: 718-984-1296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number0044621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: