Individual
DR. CHRISTIE LAUREN CUSTODIO-LUMSDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MS, RD, CDN
Contact information
Practice address
622 W 168TH ST PH 7-322, NEW YORK, NY 10032-3720
(212) 342-0137
Mailing address
112 SHORE RD, BABYLON, NY 11702-3927
(516) 991-5817
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
007380
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007380
NEW YORK STATE DIETETICS-NUTRITION LICENSE/CERTIFICATION ID
—
01
—
1014411
COMMISSION ON DIETETIC REGISTRATION ID
NY
Enumeration date
06/17/2021
Last updated
06/17/2021
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