Ilisa R Young, PHD, RD, CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

002317 Issued in NY

Practice address

401 E 88TH St
Suite 10E
New York, NY 10128-6605

Phone

(212) 860-4776

Fax

(212) 860-4776

NPI assigned

Jan 22, 2009

Last updated

Jan 22, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Lisa R Young Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232582400000",
    "number": "1215175633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E 88TH ST",
            "address_2": "SUITE 10E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101286605",
            "telephone_number": "212-860-4776",
            "fax_number": "212-860-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E 88TH ST",
            "address_2": "SUITE 10E",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101286605",
            "telephone_number": "212-860-4776",
            "fax_number": "212-860-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "ILISA",
        "middle_name": "R",
        "credential": "PHD, RD, CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-22",
        "last_updated": "2009-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "NY",
            "license": "002317",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "002317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "YOUNG",
            "middle_name": "R",
            "credential": "PHD, RD, CDN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• George P H Young, MD
• Glenn Young
• Gloria Young
• Healy Young, DDS
• Hillary Young, LMHC
• Ivan Young, M.D.
• Jade Young, MD
• James Fredrick Patrick Young Jr., LCSW
• James Jacob Young, MD PHD
• James W Young, MD

• Registered Dietitian in New York, NY
• Providers in New York, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.