Individual provider Active NPI

Lisa Beth Stollman, MA, RD, CDE, CDN

  • Registered Dietitian
  • Huntington, NY
National Provider Identifier
1184708463
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
001987-1 Issued in NY
Practice address
241 E Main St
Huntington, NY 11743-2924
Phone
(631) 757-7406
Fax
(631) 757-7406
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 001987-1 NY Primary

Addresses

Primary practice location

241 E Main St
Huntington, NY 11743-2924

Mailing address

103 Sea Cove Rd
Northport, NY 11768-1850
Phone (631) 757-7406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041109001245 NY Practitioner - Registered Dietitian Or Nutrition Professional 2961465059 Practice locations: New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

601 Lexington Ave
Suite 1070
New York, NY 10022-4611
Phone (917) 853-6362

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
001987NYMDMental Health Counselor
001987-1NYMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Fay Nutrition Dietitian, Registered Past Accepting new patients
Nourish, Inc. Dietitian, Registered Past Accepting new patients
Speech Matters SLP PLLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1184708463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SEA COVE RD",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681850",
            "telephone_number": "631-757-7406",
            "fax_number": "631-757-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 E MAIN ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432924",
            "telephone_number": "631-757-7406",
            "fax_number": "631-757-7406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLLMAN",
        "first_name": "LISA",
        "middle_name": "BETH",
        "credential": "MA, RD, CDE, CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "001987-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.