Provider Demographics
NPI:1245408889
Name:MAYERI, STEPHEN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAY
Last Name:MAYERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1340
Mailing Address - Country:US
Mailing Address - Phone:312-316-3333
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:T-209
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2259
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044555390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program