Provider Demographics
NPI:1114788072
Name:NUTRITION BY JEM PLLC
Entity Type:Organization
Organization Name:NUTRITION BY JEM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERGRUEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:516-724-3894
Mailing Address - Street 1:338 JERICHO TPKE STE 122
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 MELANIE LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5832
Practice Address - Country:US
Practice Address - Phone:516-724-3894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty