Provider Demographics
NPI:1003020462
Name:IACONO, LAURA LYNN (RD CDN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:IACONO
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0357
Mailing Address - Country:US
Mailing Address - Phone:516-286-5255
Mailing Address - Fax:
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:STE 300
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3048
Practice Address - Country:US
Practice Address - Phone:516-627-0303
Practice Address - Fax:516-627-0552
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001919133N00000X, 133NN1002X
IL834048133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric