Provider Demographics
NPI:1093968000
Name:J. GERALD MEAGHER MD PC
Entity Type:Organization
Organization Name:J. GERALD MEAGHER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-368-2828
Mailing Address - Street 1:635 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1703
Mailing Address - Country:US
Mailing Address - Phone:631-368-2828
Mailing Address - Fax:631-368-2042
Practice Address - Street 1:635 PULASKI RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1703
Practice Address - Country:US
Practice Address - Phone:631-368-2828
Practice Address - Fax:631-368-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY78545207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00671678Medicaid
C07309Medicare UPIN
NY255981Medicare PIN