Provider Demographics
NPI:1992221873
Name:MC ILROY, EMILIE (RD, CDN)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:MC ILROY
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:ROSANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RD CDN
Mailing Address - Street 1:73 HILL ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5005
Practice Address - Country:US
Practice Address - Phone:845-547-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86032485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered