1679513865 NPI number — JEREMY NEIL MEISEL MD

Table of content: JEREMY NEIL MEISEL MD (NPI 1679513865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679513865 NPI number — JEREMY NEIL MEISEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEISEL
Provider First Name:
JEREMY
Provider Middle Name:
NEIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679513865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1579 MONROE DR NE STE F
Provider Second Line Business Mailing Address:
STE F 602
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30324-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-243-2938
Provider Business Mailing Address Fax Number:
215-243-2938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1579 MONROE DR NE STE F
Provider Second Line Business Practice Location Address:
STE F 602
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30324-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-243-2938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  220035 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: MD 425502 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 10177 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: 052786 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)