MEDICARE: LARA STACIE MOST MS, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	933699	NY

General Provider Information

NPI Number	:	1144288598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA STACIE MOST MS, RD

Provider Business Mailing Address
First Line	:	200 E 58TH ST
Second Line	:	12B
City	:	NEW YORK
State	:	NY
Zip	:	10022-2025
Country	:	US
Telephone Number	:	212-980-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E 58TH ST
Second Line	:	12B
City	:	NEW YORK
State	:	NY
Zip	:	10022-2025
Country	:	US
Telephone Number	:	212-980-1999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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