1285036731 NPI number — MRS. MIRIAM FRUCHT MS, RD, CDN

Table of content: MRS. MIRIAM FRUCHT MS, RD, CDN (NPI 1285036731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285036731 NPI number — MRS. MIRIAM FRUCHT MS, RD, CDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRUCHT
Provider First Name:
MIRIAM
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285036731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10240 67TH RD
Provider Second Line Business Mailing Address:
APT 1T
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-2663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-742-7658
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10240 67TH RD
Provider Second Line Business Practice Location Address:
APT 1T
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-742-7658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1023258 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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