| Doctor Name: | LISA ROUSSO |
| NPI Number: | 1235385618 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD |
| License Number: | 004833 |
| Business Practice Address: | 11420 Rockaway Blvd South Ozone Park, NY - 114201912 |
| Business Phone Number: | 6462295575 |
| Business Fax Number: | 9173002125 |
| Mailing Address: | 110-11 Queens Blvd #9-d, FOREST HILLS |
| State: | NY |
| Postal Code: | 113756551 |
| Phone Number: | 6462295575 |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2008 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 004833 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |