Provider Demographics
NPI:1245820141
Name:MIRZA, MUZNAH (MS, RD)
Entity type:Individual
Prefix:
First Name:MUZNAH
Middle Name:
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 EILEEN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1354
Mailing Address - Country:US
Mailing Address - Phone:973-204-2423
Mailing Address - Fax:
Practice Address - Street 1:271 RTE 46 W STE C103
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2457
Practice Address - Country:US
Practice Address - Phone:973-939-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty