Provider Demographics
NPI:1376603118
Name:MEJIAS, ERENIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERENIO
Middle Name:
Last Name:MEJIAS
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 1:505 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1622
Mailing Address - Country:US
Mailing Address - Phone:908-354-5461
Mailing Address - Fax:908-354-5462
Practice Address - Street 1:505 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1622
Practice Address - Country:US
Practice Address - Phone:908-354-5461
Practice Address - Fax:908-354-5462
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03870300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000082600OtherAMERICHOICE
0935662003OtherCIGNA
NY2598273OtherGHI
F02912OtherHEALTHNET
NJ1033890OtherHORIZON BC BS OF NJ
NJ1611101Medicaid
NJ1033890OtherHORIZON BC BS OF NJ
NJME408576Medicare ID - Type Unspecified