Provider Demographics
NPI:1114967346
Name:CRASSI, LORI M (RD/CDE)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:CRASSI
Suffix:
Gender:F
Credentials:RD/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LIONEL R JOHN HEALTH CENTER
Mailing Address - Street 2:987 RC HOAG DRIVE
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779
Mailing Address - Country:US
Mailing Address - Phone:716-945-5894
Mailing Address - Fax:716-945-5889
Practice Address - Street 1:LIONEL R JOHN HEALTH CENTER
Practice Address - Street 2:987 RC HOAG DRIVE
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779
Practice Address - Country:US
Practice Address - Phone:716-945-5894
Practice Address - Fax:716-945-5889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003086133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526924001OtherBC/BS OF WNY
NY000526924001OtherBC/BS OF WNY