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General NPI Number Information
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NPI Number | 1114315033
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Entity Type | Individual
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Provider Name | MAJA MIRKOVIC RD, CDE, BC-ADM
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Gender | Female
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 745 5TH AVE STE 500
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City | NEW YORK
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State | NY
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Zip | 10151-0099
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Country | US
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Telephone | 347-265-1148
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Fax | 855-817-0064
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Provider Business Mailing Address
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Address Line | 2944 W 5TH ST APT 14S
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City | BROOKLYN
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State | NY
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Zip | 11224-3844
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Country | US
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Telephone | 347-265-1148
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Fax | 855-817-0064
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 007093
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License Number State | NY
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