Organization
EAT LIVE NUTRITION, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY LAURIN MS, RD, CDN (REGISTERED DIETITIAN)
(585) 703-2739
Entity
Organization
Contact information
Practice address
1026 UNION RD, WEST SENECA, NY 14224-3445
(716) 217-1004
Mailing address
198 OEHMAN BLVD, CHEEKTOWAGA, NY 14225-1608
(585) 703-2739
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
007596-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811252604
NPI
—
01
—
J400201451
MEDICARE
NY
Enumeration date
09/01/2016
Last updated
04/05/2017
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