Provider Demographics
NPI:1720432966
Name:KUSOVITSKY, LEIGH (MPH, RD, CDN)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:KUSOVITSKY
Suffix:
Gender:F
Credentials:MPH, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 56TH ST
Mailing Address - Street 2:APT 23H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 CORTLANDT ST
Practice Address - Street 2:SUITE 1632
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3107
Practice Address - Country:US
Practice Address - Phone:203-520-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered