Healthcare Provider Details

I. General information

NPI: 1184714818
Provider Name (Legal Business Name): EDWARD ANTHONY LEMMO PH.D., RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GILROY ST
STATEN ISLAND NY
10309-1710
US

IV. Provider business mailing address

60 GILROY ST
STATEN ISLAND NY
10309-1710
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-5880
  • Fax:
Mailing address:
  • Phone: 718-967-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number002858-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: