Provider Demographics
NPI:1629651989
Name:LI NUTRITIONIST PLLC
Entity Type:Organization
Organization Name:LI NUTRITIONIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIDANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:516-581-2217
Mailing Address - Street 1:5 HILLTURN LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2306
Mailing Address - Country:US
Mailing Address - Phone:516-581-2217
Mailing Address - Fax:
Practice Address - Street 1:5 HILLTURN LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2306
Practice Address - Country:US
Practice Address - Phone:516-581-2217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty