Provider Demographics
NPI:1194339390
Name:HERSCHLAG, JILLIAN ROSE (MS, RD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ROSE
Last Name:HERSCHLAG
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 STANTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVALE
Mailing Address - State:PA
Mailing Address - Zip Code:15209-2743
Mailing Address - Country:US
Mailing Address - Phone:412-427-1096
Mailing Address - Fax:
Practice Address - Street 1:3601 5TH AVE STE 3B
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3403
Practice Address - Country:US
Practice Address - Phone:412-586-9737
Practice Address - Fax:412-586-9692
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered