Individual provider Active NPI

Mia Sugarman

  • Registered Dietitian
  • New York, NY
National Provider Identifier
1366215410
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
245 E 63Rd St Apt 1111
New York, NY 10065-7457
Phone
(857) 544-5309
NPI assigned
Oct 31, 2023
Last updated
Jan 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NY Primary

Addresses

Primary practice location

245 E 63Rd St Apt 1111
New York, NY 10065-7457

Mailing address

55 Centre St
Woodmere, NY 11598-1304
Phone (857) 544-5309

Other identifiers 1

IdentifierTypeStateIssuer
366215410OtherBELLY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260108002599 NY Practitioner - Registered Dietitian Or Nutrition Professional 2163908294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

705 Caffrey Ave
Far Rockaway, NY 11691-5301

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011755NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Azriel Hirschfeld MD PLLC CurrentSince Dec 1, 2025 Accepting new patients
Boro Park Dietitian Dietitian, Registered PastSince Jan 28, 2024 Accepting new patients
Boro Park Nutrition, LLC PastSince Nov 1, 2023 Accepting new patients

Locations

2330 Eastchester Rd
Bronx, NY 10469
Phone (718) 228-0063

16 Sumner Pl
Fl 4
Brooklyn, NY 11206
Phone (212) 235-5181

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1366215410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 CENTRE ST",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981304",
            "telephone_number": "857-544-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 E 63RD ST APT 1111",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100657457",
            "telephone_number": "857-544-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUGARMAN",
        "first_name": "MIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-31",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BELLY",
            "identifier": "366215410",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.