Individual
JOELLE B PORUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 S OYSTER BAY RD STE 300, HICKSVILLE, NY 11801-3500
(215) 776-0389
Mailing address
30 WALTER CT, COMMACK, NY 11725-3602
(631) 592-8415
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
86066500
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86066500
LICENSE
—
Enumeration date
09/04/2020
Last updated
09/04/2020
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