Individual
LAURA CUSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
245 PAK AVE., NEW YORK, NY 10167
(475) 529-9139
Mailing address
245 PAK AVE., NEW YORK, NY 10167
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1058541
CT
Other
Enumeration date
10/23/2013
Last updated
01/24/2014
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