Provider Demographics
NPI:1891560348
Name:VAN HARN, MIRIAM (RDN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:VAN HARN
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 1:975 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3204
Mailing Address - Country:US
Mailing Address - Phone:718-320-4466
Mailing Address - Fax:718-991-3829
Practice Address - Street 1:975 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3204
Practice Address - Country:US
Practice Address - Phone:718-320-4466
Practice Address - Fax:718-991-3829
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011575-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered