Provider Demographics
NPI:1043805112
Name:MILLER, MALKA (MS, RDN, CNSC)
Entity type:Individual
Prefix:
First Name:MALKA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, RDN, CNSC
Other - Prefix:
Other - First Name:MALKA
Other - Middle Name:
Other - Last Name:ZENTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RDN, CNSC
Mailing Address - Street 1:24 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3221
Mailing Address - Country:US
Mailing Address - Phone:718-877-4439
Mailing Address - Fax:
Practice Address - Street 1:24 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-3221
Practice Address - Country:US
Practice Address - Phone:718-877-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY986099133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered