Provider Demographics
NPI:1043943897
Name:MEYERHOFF, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MEYERHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S WASHINGTON ST APT 101N
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-2923
Mailing Address - Country:US
Mailing Address - Phone:856-350-8383
Mailing Address - Fax:
Practice Address - Street 1:180 S WASHINGTON ST APT 101N
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2923
Practice Address - Country:US
Practice Address - Phone:856-350-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician