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General NPI Number Information
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NPI Number | 1154805554
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Entity Type | Individual
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Provider Name | JILLIAN MERGRUEN RD, CDN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 88 REGENT ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-7602
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Country | US
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Telephone | 516-604-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 338 JERICHO TPKE STE 122
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City | SYOSSET
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State | NY
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Zip | 11791-4507
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Country | US
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Telephone | 516-724-3894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86056868
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License Number State | IL
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