Provider Demographics
NPI:1346499878
Name:PRINGLE, ROAN ELAINE (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:ROAN
Middle Name:ELAINE
Last Name:PRINGLE
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 1:674 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1204
Mailing Address - Country:US
Mailing Address - Phone:718-531-4644
Mailing Address - Fax:718-221-1356
Practice Address - Street 1:674 E 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1204
Practice Address - Country:US
Practice Address - Phone:718-531-4644
Practice Address - Fax:718-221-1356
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002555133N00000X
NY00874343133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist