Provider Demographics
NPI:1902138555
Name:HERMANSKY, JESSICA L (RD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:HERMANSKY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224 HAMBURG TPKE
Mailing Address - Street 2:DIABETES EDUCATION PROGRAM
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2111
Mailing Address - Country:US
Mailing Address - Phone:973-720-6733
Mailing Address - Fax:973-389-4098
Practice Address - Street 1:224 HAMBURG TPKE
Practice Address - Street 2:DIABETES EDUCATION PROGRAM
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2111
Practice Address - Country:US
Practice Address - Phone:973-720-6733
Practice Address - Fax:973-389-4098
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1020259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered