Individual
MRS. ELAINE MARGARET RIDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
160 E MAIN ST, PORT JERVIS, NY 12771-2253
(845) 858-7067
Mailing address
30 GLASS ST, PORT JERVIS, NY 12771-1629
(845) 858-7967
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
006814
NY
Other
Enumeration date
11/15/2010
Last updated
11/15/2010
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