Provider Demographics
NPI:1225215114
Name:ROSEN, LESLIE APRIL (MS RD CDN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:APRIL
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 S OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4937
Mailing Address - Country:US
Mailing Address - Phone:516-643-9976
Mailing Address - Fax:
Practice Address - Street 1:281 S OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4937
Practice Address - Country:US
Practice Address - Phone:516-643-9976
Practice Address - Fax:516-763-1772
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered