Most Relevant Information
Provider Data
| NPI Number: | 1003020462 |
| Provider Name: | LAURA LYNN IACONO RD CDN |
| Entity Type: | Individual |
| Taxonomy Code: | 133N00000X |
| Specialty: | Nutritionist |
| License Number: | 001919 |
Most Important Dates
| Enumeration Date: | 05/09/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1165 NORTHERN BLVD
STE 300
MANHASSET
NY
110303048
Practice Location Phone/Fax
| Phone: | 5166270303 |
| Fax: | 5166270552 |
Provider Mailing Location
PO BOX 357
SYOSSET
NY
117910357
Provider Mailing Phone/Fax
| Phone: | 5162865255 |
| Fax: |