Provider Demographics
NPI:1447244520
Name:MEYER, MONICA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RUTH
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ELWYN LANE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1301
Mailing Address - Country:US
Mailing Address - Phone:845-679-0100
Mailing Address - Fax:845-679-3324
Practice Address - Street 1:9 ELWYN LANE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1301
Practice Address - Country:US
Practice Address - Phone:845-679-0100
Practice Address - Fax:845-679-3324
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123815208000000X, 2080A0000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00710792Medicaid
NYRA2839Medicare ID - Type Unspecified
NY00710792Medicaid