Provider Demographics
NPI:1952069833
Name:MUKHERJEE, MOUSHUMI (RDN)
Entity Type:Individual
Prefix:MRS
First Name:MOUSHUMI
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MRS
Other - First Name:MOUSHUMI
Other - Middle Name:
Other - Last Name:MUKHERJEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:2700 LOON LN
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3352
Mailing Address - Country:US
Mailing Address - Phone:732-762-1068
Mailing Address - Fax:
Practice Address - Street 1:2700 LOON LN
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3352
Practice Address - Country:US
Practice Address - Phone:732-762-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological