Provider Demographics
NPI:1538673447
Name:BENEDIKT, MIRIAM (RDN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BENEDIKT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DANIELLE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2928
Mailing Address - Country:US
Mailing Address - Phone:718-915-3481
Mailing Address - Fax:
Practice Address - Street 1:4 DANIELLE CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2928
Practice Address - Country:US
Practice Address - Phone:718-915-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86038906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered