Provider Demographics
NPI:1437206687
Name:DRISCOLL, ELLEN M (RD CDE)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1326
Mailing Address - Country:US
Mailing Address - Phone:516-338-5239
Mailing Address - Fax:
Practice Address - Street 1:20 TITUS AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1326
Practice Address - Country:US
Practice Address - Phone:516-338-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5860941133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered