Lisa Rousso, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

004833 Issued in NY

Practice address

11420 Rockaway Blvd
South Ozone Park, NY 11420-1912

Phone

(646) 229-5575

Fax

(917) 300-2125

NPI assigned

Aug 17, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1218931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444003200000",
    "number": "1235385618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110-11 QUEENS BLVD #9-D",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113756551",
            "telephone_number": "646-229-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11420 ROCKAWAY BLVD",
            "city": "SOUTH OZONE PARK",
            "state": "NY",
            "postal_code": "114201912",
            "telephone_number": "646-229-5575",
            "fax_number": "917-300-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSO",
        "first_name": "LISA",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-17",
        "last_updated": "2015-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "004833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in South Ozone Park, NY
• Providers in South Ozone Park, 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 Oct 5, 2015; 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.