Provider Demographics
NPI:1114315033
Name:MIRKOVIC, MAJA (RD, CDE, BC-ADM)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:MIRKOVIC
Suffix:
Gender:F
Credentials:RD, CDE, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 W 5TH ST APT 14S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3844
Mailing Address - Country:US
Mailing Address - Phone:347-265-1148
Mailing Address - Fax:855-817-0064
Practice Address - Street 1:745 5TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10151-0099
Practice Address - Country:US
Practice Address - Phone:347-265-1148
Practice Address - Fax:855-817-0064
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331043Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331946Medicare Oscar/Certification