Provider Demographics
NPI:1427568047
Name:GEISSLER, MALISSA (MS, RD, CDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MALISSA
Middle Name:
Last Name:GEISSLER
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4802
Mailing Address - Country:US
Mailing Address - Phone:516-364-3609
Mailing Address - Fax:
Practice Address - Street 1:100 MANETTO HILL RD STE 205
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-736-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005301133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered