Healthcare Provider Details

I. General information

NPI: 1316230410
Provider Name (Legal Business Name): ROGER ELROY WARN MS, RDN, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 RESERVOIR AVE
DOVER NJ
07801-4819
US

IV. Provider business mailing address

18 RESERVOIR AVE
DOVER NJ
07801-4819
US

V. Phone/Fax

Practice location:
  • Phone: 201-819-9217
  • Fax:
Mailing address:
  • Phone: 201-819-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: