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General NPI Number Information
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NPI Number | 1184708463
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Entity Type | Individual
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Provider Name | LISA BETH STOLLMAN MA, RD, CDE, CDN
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 241 E MAIN ST
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City | HUNTINGTON
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State | NY
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Zip | 11743-2924
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Country | US
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Telephone | 631-757-7406
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Fax | 631-757-7406
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Provider Business Mailing Address
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Address Line | 103 SEA COVE RD
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City | NORTHPORT
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State | NY
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Zip | 11768-1850
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Country | US
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Telephone | 631-757-7406
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Fax | 631-757-7406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 001987-1
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License Number State | NY
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