Provider Demographics
NPI:1336472133
Name:MCKIE, HERMAN JR (MS, RD)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:MCKIE
Suffix:JR
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1002
Mailing Address - Country:US
Mailing Address - Phone:646-406-9616
Mailing Address - Fax:
Practice Address - Street 1:380 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1002
Practice Address - Country:US
Practice Address - Phone:646-406-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered