Provider Demographics
NPI:1710124318
Name:BERGMAN, JILL (MS, RD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BERGMAN
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 1:80 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3741
Mailing Address - Country:US
Mailing Address - Phone:856-419-2686
Mailing Address - Fax:609-573-5212
Practice Address - Street 1:80 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-3741
Practice Address - Country:US
Practice Address - Phone:856-419-2686
Practice Address - Fax:609-573-5212
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered