Provider Demographics
NPI:1720684046
Name:OYAMA, HARUKO (MS, RD, CDN, CNSC)
Entity type:Individual
Prefix:MRS
First Name:HARUKO
Middle Name:
Last Name:OYAMA
Suffix:
Gender:F
Credentials:MS, RD, CDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2211
Mailing Address - Country:US
Mailing Address - Phone:914-406-5126
Mailing Address - Fax:
Practice Address - Street 1:4256 BRONX BLVD STE 9
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2673
Practice Address - Country:US
Practice Address - Phone:718-547-2011
Practice Address - Fax:718-547-0341
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006616-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered