Provider Demographics
NPI:1154805554
Name:MERGRUEN, JILLIAN (RD, CDN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MERGRUEN
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 E 32ND ST
Mailing Address - Street 2:FLOOR 10
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:516-724-3894
Mailing Address - Fax:
Practice Address - Street 1:38 E 32ND ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5562
Practice Address - Country:US
Practice Address - Phone:212-685-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86056868133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered