Provider Demographics
NPI:1407619224
Name:TRINKWALD, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TRINKWALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2848
Mailing Address - Country:US
Mailing Address - Phone:516-690-3657
Mailing Address - Fax:
Practice Address - Street 1:246 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2249
Practice Address - Country:US
Practice Address - Phone:631-252-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist