Provider Demographics
NPI:1316230410
Name:WARN, ROGER ELROY (MS, RDN, CDE)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ELROY
Last Name:WARN
Suffix:
Gender:M
Credentials:MS, RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4819
Mailing Address - Country:US
Mailing Address - Phone:201-819-9217
Mailing Address - Fax:
Practice Address - Street 1:18 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4819
Practice Address - Country:US
Practice Address - Phone:201-819-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered