Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | MD002137 | NJ |
NPI | 1407845142 |
---|---|
Provider Name | Dr. Brian Meyerberg |
First Address | Whiting, NJ 08759-2938 |
Second Address | Whiting, NJ 08759-2938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2005 |
Last Update Date | 01/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480018620 | PALMETTO GBA RAILROAD (01) | NJ |
5614805 | (05) | NJ |
U31901 | (02) | NJ |