Individual
LAURA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1498 CLOVE RD, STATEN ISLAND, NY 10301-4314
(718) 494-2690
Mailing address
32 ALLEN CT, STATEN ISLAND, NY 10310-2703
(718) 640-7774
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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