Individual
MRS. ILENE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
49 OAKCREST AVE, MIDDLE ISLAND, NY 11953-1415
(516) 697-7383
Mailing address
2 LEEDS LN, NORTH BABYLON, NY 11703-2902
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
858851
NY
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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