1689886079 NPI number — MEYEROVICH MEDICAL & DIAGNOSTIC PC

Table of content: (NPI 1689886079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689886079 NPI number — MEYEROVICH MEDICAL & DIAGNOSTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEYEROVICH MEDICAL & DIAGNOSTIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1689886079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9811 QUEENS BLVD
Provider Second Line Business Mailing Address:
SUITE 1E
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-830-0400
Provider Business Mailing Address Fax Number:
718-830-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9811 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-830-0400
Provider Business Practice Location Address Fax Number:
718-830-0005
Provider Enumeration Date:
05/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEYEROVICH
Authorized Official First Name:
INESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-830-0400

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  218770 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 217870 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02228682 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com