Healthcare Provider Details

I. General information

NPI: 1578661948
Provider Name (Legal Business Name): RITA ROVER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 LAUREL AVE
NORTHPORT NY
11768-3168
US

IV. Provider business mailing address

311 ASHAROKEN AVE
NORTHPORT NY
11768-1168
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-8386
  • Fax:
Mailing address:
  • Phone: 631-261-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000197-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: