Organization
LILAC NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE DOWD NDTR, CLC (OWNER)
(631) 774-1565
Entity
Organization
Contact information
Practice address
2 DUBON CT, FARMINGDALE, NY 11735-1031
(631) 210-6362
Mailing address
712 OAK NECK RD, WEST ISLIP, NY 11795-3619
(631) 210-6362
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
136A00000X
Registered Dietetic Technician
—
—
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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