Provider Demographics
NPI:1578773818
Name:ENGLISH, ROXANNE N (IBCLC,CDN)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:N
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:IBCLC,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PINE ST
Mailing Address - Street 2:APARTMENT 2 C
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3529
Mailing Address - Country:US
Mailing Address - Phone:516-771-9364
Mailing Address - Fax:
Practice Address - Street 1:408 ROCKAWAY AVE
Practice Address - Street 2:WIC PROGRAM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5634
Practice Address - Country:US
Practice Address - Phone:718-345-6366
Practice Address - Fax:718-345-8988
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003634-1133N00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered174400000XOther Service ProvidersSpecialist