Provider Demographics
NPI:1487636726
Name:GRIFFIN, MERVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MERVIN
Middle Name:
Last Name:GRIFFIN
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 1:20 LIVINGSTON AVE UNIT 401
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1991
Mailing Address - Country:US
Mailing Address - Phone:917-881-1223
Mailing Address - Fax:
Practice Address - Street 1:20 LIVINGSTON AVE UNIT 401
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1991
Practice Address - Country:US
Practice Address - Phone:917-881-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024696207P00000X
NY213359207P00000X
NJ25MA08065400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051509907Medicaid
AL930118897OtherRRMC PROVIDER NUMBER
NJP00451724OtherRAILROAD MEDICARE
NJ0107336Medicaid
NJ91002398002/NON PAROtherAMERICHOICE/KING
AL051509907OtherBCBS PROVIDER NUMBER
NJ113079VA1Medicare PIN
NJP00451724OtherRAILROAD MEDICARE
ALH06727Medicare UPIN
AL051509907Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
AL930118897OtherRRMC PROVIDER NUMBER