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Individual

MRS. RITA M ROSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
10 BENTON AVENUE, MIDDLETOWN, NY 10940
(845) 343-8838
(845) 343-7017
Mailing address
PO BOX 987, 21 ORCHARD STREET, MIDDLETOWN, NY 10940
(845) 343-7614
(845) 343-5390

Taxonomy

Speciality
Code
Description
License number
State
133N00000X
Nutritionist
002009
NY
133V00000X
Registered Dietitian
Primary
002009
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002009
LIC NUMBER
NY
05
00355931
NY
Enumeration date
02/20/2008
Last updated
02/20/2008
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