Provider Demographics
NPI:1013537034
Name:LEAH MARK INTEGRATIVE NUTRITION PLLC
Entity Type:Organization
Organization Name:LEAH MARK INTEGRATIVE NUTRITION PLLC
Other - Org Name:COASTAL NUTRITION COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:516-810-8808
Mailing Address - Street 1:6 PLOVER LN
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1037
Mailing Address - Country:US
Mailing Address - Phone:516-810-8808
Mailing Address - Fax:516-300-1492
Practice Address - Street 1:44 GREEN ST STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3393
Practice Address - Country:US
Practice Address - Phone:516-806-0045
Practice Address - Fax:516-861-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty