MEDICARE: LESASH NUTRITION & HEALTH, LLC

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	133N00000X	Nutritionist	003629-1	NY
2	133V00000X	Registered Dietitian	003629-1	NY
3	133NN1002X	Nutrition Education Nutritionist	003629-1	NY

General Provider Information

NPI Number	:	1699009662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESASH NUTRITION & HEALTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 320648
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11232-0648
Country	:	US
Telephone Number	:	347-242-9804
Fax Number	:	718-981-4580

Provider Business Practice Location Address
First Line	:	256 SKYLINE DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4770
Country	:	US
Telephone Number	:	347-242-9804
Fax Number	:	718-981-4580

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JENNILYN JACKMAN BAPTISTE
Credential	:	RD, CDN
Telephone Number	:	347-242-9804

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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