Organization
LIPID (AKA)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARYN NISTICO MS,RDN,CDN (PRESIDENT/CONSULTING REG DIETITIAN)
(631) 425-1578
Entity
Organization
Contact information
Practice address
153 BEVERLY RD, HUNTINGTON STATION, NY 11746-4522
(631) 425-1578
(631) 425-1578
Mailing address
153 BEVERLY RD, HUNTINGTON STATION, NY 11746-4522
(631) 425-1578
(631) 425-1578
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
002667-1
NY
133V00000X
Registered Dietitian
Primary
002667-1
NY
133VN1005X
Renal Nutrition Registered Dietitian
002667-1
NY
Other
Enumeration date
01/29/2014
Last updated
01/29/2014
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