Provider Demographics
NPI:1093189748
Name:HAYIM, LISA B (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:B
Last Name:HAYIM
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NORTHERN BLVD STE 208
Mailing Address - Street 2:ROOM 22
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5320
Mailing Address - Country:US
Mailing Address - Phone:516-428-6038
Mailing Address - Fax:
Practice Address - Street 1:1010 NORTHERN BLVD STE 208
Practice Address - Street 2:ROOM 22
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5320
Practice Address - Country:US
Practice Address - Phone:516-428-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered