Provider Demographics
NPI:1497441943
Name:MCMAHON, LAURIE-ANN
Entity Type:Individual
Prefix:
First Name:LAURIE-ANN
Middle Name:
Last Name:MCMAHON
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 1:3 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1904
Mailing Address - Country:US
Mailing Address - Phone:631-263-3819
Mailing Address - Fax:
Practice Address - Street 1:1991 MARCUS AVE STE M100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2062
Practice Address - Country:US
Practice Address - Phone:516-472-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered