Healthcare Provider Details

I. General information

NPI: 1285036731
Provider Name (Legal Business Name): MIRIAM FRUCHT MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 67TH RD APT 1T
FOREST HILLS NY
11375-2663
US

IV. Provider business mailing address

10240 67TH RD APT 1T
FOREST HILLS NY
11375-2663
US

V. Phone/Fax

Practice location:
  • Phone: 347-742-7658
  • Fax:
Mailing address:
  • Phone: 347-742-7658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1023258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: