Individual
LISA ROUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
11420 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-1912
(646) 229-5575
(917) 300-2125
Mailing address
110-11 QUEENS BLVD #9-D, FOREST HILLS, NY 11375-6551
(646) 229-5575
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
004833
NY
Other
Enumeration date
08/17/2008
Last updated
10/05/2015
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