Individual
MS. LISA BROOKE SAMUELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
67 PROSPECT AVE, #12-C, HEWLETT, NY 11557-1640
(516) 993-3267
(516) 239-5167
Mailing address
67 PROSPECT AVE, #12-C, HEWLETT, NY 11557-1640
(516) 993-3267
(516) 239-5167
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86034080
NY
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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