Provider Demographics
NPI:1922741776
Name:GATTI, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GATTI
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 1:45 CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8205
Mailing Address - Country:US
Mailing Address - Phone:203-856-7788
Mailing Address - Fax:
Practice Address - Street 1:411 THEODORE FREMD AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1410
Practice Address - Country:US
Practice Address - Phone:203-423-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist