Provider Demographics
NPI:1023325339
Name:POLMANTEER, LYNN MARIE (MS, RD, CDN, CDE)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:POLMANTEER
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:PO BOX 95000-2433
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2433
Mailing Address - Country:US
Mailing Address - Phone:212-420-3450
Mailing Address - Fax:212-420-2224
Practice Address - Street 1:317 E 17TH ST
Practice Address - Street 2:8TH FLOOR FIERMAN HALL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-420-3450
Practice Address - Fax:212-420-2224
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006297-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered