Provider Demographics
NPI:1194052787
Name:HUBBELL, LAWRENCE BAYNARD (MS, RD, CDN)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:BAYNARD
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 45TH ST APT 18E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3838
Mailing Address - Country:US
Mailing Address - Phone:917-280-6613
Mailing Address - Fax:
Practice Address - Street 1:1315 LOOMIS ST
Practice Address - Street 2:LIFESPIRE CLINIC SERVICES
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2310
Practice Address - Country:US
Practice Address - Phone:718-892-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48 006816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered