Provider Demographics
NPI:1013325729
Name:GOLDBLATT, MIRIAM (RD)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:GOLDBLATT
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 1:579 A CRANBURY ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:E BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5405
Mailing Address - Country:US
Mailing Address - Phone:732-613-0711
Mailing Address - Fax:
Practice Address - Street 1:27 EDGEMOUNT RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2904
Practice Address - Country:US
Practice Address - Phone:732-322-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ832946133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered