Healthcare Provider Details

I. General information

NPI: 1083424394
Provider Name (Legal Business Name): SHIFRA ZUCKERMAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40-01 MARIE CT
FAIR LAWN NJ
07410-5108
US

IV. Provider business mailing address

40-01 MARIE CT
FAIR LAWN NJ
07410-5108
US

V. Phone/Fax

Practice location:
  • Phone: 551-501-6512
  • Fax:
Mailing address:
  • Phone: 551-501-6512
  • 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: