Provider Demographics
NPI:1124832431
Name:LILAC NUTRITION LLC
Entity type:Organization
Organization Name:LILAC NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:NDTR, CLC
Authorized Official - Phone:631-774-1565
Mailing Address - Street 1:712 OAK NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3619
Mailing Address - Country:US
Mailing Address - Phone:631-210-6362
Mailing Address - Fax:
Practice Address - Street 1:2 DUBON CT
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1031
Practice Address - Country:US
Practice Address - Phone:631-210-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Multi-Specialty