Provider Demographics
NPI:1043511504
Name:RIDLEY, ELAINE MARGARET (RD)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARGARET
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GLASS ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1629
Mailing Address - Country:US
Mailing Address - Phone:845-858-7967
Mailing Address - Fax:
Practice Address - Street 1:160 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2253
Practice Address - Country:US
Practice Address - Phone:845-858-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered