Provider Demographics
NPI:1093017568
Name:GROSS, MIRIAM REBECCA (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:REBECCA
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:REBECCA
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:1615 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3708
Mailing Address - Country:US
Mailing Address - Phone:818-633-2260
Mailing Address - Fax:
Practice Address - Street 1:1615 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3708
Practice Address - Country:US
Practice Address - Phone:818-633-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered