Provider Demographics
NPI:1578805925
Name:MEHRJUI, MARYAM (RN)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:MEHRJUI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E 82ND ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7114
Mailing Address - Country:US
Mailing Address - Phone:718-974-1461
Mailing Address - Fax:
Practice Address - Street 1:510 E 82ND ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7114
Practice Address - Country:US
Practice Address - Phone:718-974-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565763163W00000X
NY005507171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse