Provider Demographics
NPI:1699009662
Name:LESASH NUTRITION & HEALTH, LLC
Entity Type:Organization
Organization Name:LESASH NUTRITION & HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNILYN
Authorized Official - Middle Name:JACKMAN
Authorized Official - Last Name:BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:347-242-9804
Mailing Address - Street 1:PO BOX 320648
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-0648
Mailing Address - Country:US
Mailing Address - Phone:347-242-9804
Mailing Address - Fax:718-981-4580
Practice Address - Street 1:256 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4770
Practice Address - Country:US
Practice Address - Phone:347-242-9804
Practice Address - Fax:718-981-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003629-1133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty