Provider Demographics
NPI:1174799654
Name:SERRANO, MIRIAM (MSED, RD, CDN, CDE)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MSED, RD, CDN, CDE
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:HOEFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, RD, CDN, CDE
Mailing Address - Street 1:1727 AMSTERDAM AVENUE 4TH FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4611
Mailing Address - Country:US
Mailing Address - Phone:212-862-0054
Mailing Address - Fax:212-862-5516
Practice Address - Street 1:1727 AMSTERDAM AVENUE 4TH FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4611
Practice Address - Country:US
Practice Address - Phone:212-862-0054
Practice Address - Fax:212-862-5516
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered