Provider Demographics
NPI:1902012628
Name:JOSIPOVICH, MARGARITA RITA (RD)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:RITA
Last Name:JOSIPOVICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2518
Mailing Address - Country:US
Mailing Address - Phone:917-428-6074
Mailing Address - Fax:
Practice Address - Street 1:2705 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2005
Practice Address - Country:US
Practice Address - Phone:171-826-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1JM51AW531Medicare PIN