Provider Demographics
NPI:1164874434
Name:COOK LEARN LIVE
Entity Type:Organization
Organization Name:COOK LEARN LIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEBOWICH
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:917-834-5596
Mailing Address - Street 1:9 BURLING AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3508
Mailing Address - Country:US
Mailing Address - Phone:917-834-5596
Mailing Address - Fax:
Practice Address - Street 1:9 BURLING AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3508
Practice Address - Country:US
Practice Address - Phone:917-834-5596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1067445OtherCOMMISSION ON DIETETIC REGISTRATION