Provider Demographics
NPI:1376314120
Name:MICHAEL MAHER DIETETICS
Entity Type:Organization
Organization Name:MICHAEL MAHER DIETETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MS, CDN, CSR
Authorized Official - Phone:631-875-0672
Mailing Address - Street 1:282 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2845
Mailing Address - Country:US
Mailing Address - Phone:631-875-0672
Mailing Address - Fax:
Practice Address - Street 1:282 PARK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2845
Practice Address - Country:US
Practice Address - Phone:631-875-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty