Provider Demographics
NPI:1770986796
Name:EAST END NUTRITION, PLLC
Entity type:Organization
Organization Name:EAST END NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, CDN
Authorized Official - Phone:631-740-9330
Mailing Address - Street 1:21 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2752
Mailing Address - Country:US
Mailing Address - Phone:631-740-9330
Mailing Address - Fax:631-207-8414
Practice Address - Street 1:21 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2752
Practice Address - Country:US
Practice Address - Phone:631-740-9330
Practice Address - Fax:631-207-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-04
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty