Active NPI
Maryam Nikantabar
- Obesity and Weight Management Nutrition Registered Dietitian
- Haddonfield, NJ
National Provider Identifier
1508405994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obesity and Weight Management Nutrition Registered Dietitian
- License
- DN006783
- Practice address
- 801 Graisbury Ave
Haddonfield, NJ 08033-3021 - Phone
- (570) 985-0955
- NPI assigned
- Jan 2, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obesity and Weight Management Nutrition Registered Dietitian | 133VN1201X | DN006783 | PA | Primary |
Addresses
Primary practice location
801 Graisbury Ave
Haddonfield, NJ 08033-3021
Mailing address
435 Beech Ave
Hershey, PA 17033-1610
Phone (570) 985-0955
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN006783 | PA | MD | Obesity and Weight Management Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1508405994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "435 BEECH AVE",
"city": "HERSHEY",
"state": "PA",
"postal_code": "170331610",
"telephone_number": "570-985-0955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 GRAISBURY AVE",
"city": "HADDONFIELD",
"state": "NJ",
"postal_code": "080333021",
"telephone_number": "570-985-0955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKANTABAR",
"first_name": "MARYAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-02",
"last_updated": "2026-05-20",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1201X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
"state": "PA",
"license": "DN006783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Haddonfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.