MEDICARE: MR. LAWRENCE BAYNARD HUBBELL M.S., R.D., C.D.N.

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	48 006816	NY

General Provider Information

NPI Number	:	1194052787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE BAYNARD HUBBELL M.S., R.D., C.D.N.

Provider Business Mailing Address
First Line	:	301 W 45TH ST APT 18E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-3838
Country	:	US
Telephone Number	:	917-280-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 LOOMIS ST
Second Line	:	LIFESPIRE CLINIC SERVICES
City	:	BRONX
State	:	NY
Zip	:	10461-2310
Country	:	US
Telephone Number	:	718-892-7801
Fax Number	:

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

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	04/14/2010

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