Provider Demographics
NPI:1265471007
Name:MAYER, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MAYER
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 1:223 WALL ST STE 190
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2060
Mailing Address - Country:US
Mailing Address - Phone:631-255-3304
Mailing Address - Fax:631-364-9672
Practice Address - Street 1:1324 MOTOR PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11749-5226
Practice Address - Country:US
Practice Address - Phone:631-255-3304
Practice Address - Fax:631-364-9672
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124152208600000X
NY124152-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00315673Medicaid
C08798Medicare UPIN
75L631Medicare ID - Type Unspecified