Provider Demographics
NPI:1295113009
Name:GURSHUMOVA, MILANA (RD)
Entity type:Individual
Prefix:
First Name:MILANA
Middle Name:
Last Name:GURSHUMOVA
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 1:20 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5564
Mailing Address - Country:US
Mailing Address - Phone:732-283-1900
Mailing Address - Fax:732-898-3951
Practice Address - Street 1:98 JAMES ST STE 212
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-283-1900
Practice Address - Fax:732-898-3957
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY927426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered