Provider Demographics
NPI:1407461130
Name:MEJENNY, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MEJENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SHORE FRONT PKWY APT 10F
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-2146
Mailing Address - Country:US
Mailing Address - Phone:347-968-8983
Mailing Address - Fax:
Practice Address - Street 1:8200 SHORE FRONT PKWY APT 10F
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-2146
Practice Address - Country:US
Practice Address - Phone:347-968-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9065899604OtherEMBLEM HEALTH