Provider Demographics
NPI:1710743240
Name:MORAN, VIVIAN (MS NUTRITION)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3225
Mailing Address - Country:US
Mailing Address - Phone:917-319-6722
Mailing Address - Fax:
Practice Address - Street 1:4730 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3225
Practice Address - Country:US
Practice Address - Phone:917-319-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist