Healthcare Provider Details

I. General information

NPI: 1275177933
Provider Name (Legal Business Name): MARNIE JORDAN FRIEDMAN MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 85TH ST
NEW YORK NY
10028-3001
US

IV. Provider business mailing address

3 SEMINOLE CT
EAST BRUNSWICK NJ
08816-4028
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax: 212-410-7196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: