Provider Demographics
NPI:1285153148
Name:LCC NUTRITION GROUP, INC.
Entity type:Organization
Organization Name:LCC NUTRITION GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:212-831-7900
Mailing Address - Street 1:200 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5567
Mailing Address - Country:US
Mailing Address - Phone:646-460-0181
Mailing Address - Fax:
Practice Address - Street 1:200 W 54TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5567
Practice Address - Country:US
Practice Address - Phone:646-460-0181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency