Provider Demographics
NPI:1386649515
Name:MEYERBERG, ALAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:MEYERBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1605
Mailing Address - Country:US
Mailing Address - Phone:732-322-9887
Mailing Address - Fax:
Practice Address - Street 1:4277 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6241
Practice Address - Country:US
Practice Address - Phone:718-948-3788
Practice Address - Fax:718-948-1394
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003271213ES0103X
NJ25MD00213900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51020Medicare UPIN
NJ719530Medicare PIN
NYP34411Medicare ID - Type Unspecified