Provider Demographics
NPI:1598789844
Name:MAYOR, MAYER
Entity Type:Individual
Prefix:
First Name:MAYER
Middle Name:
Last Name:MAYOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3497
Mailing Address - Country:US
Mailing Address - Phone:718-934-8435
Mailing Address - Fax:718-934-5931
Practice Address - Street 1:3043 OCEAN AVE
Practice Address - Street 2:#201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3497
Practice Address - Country:US
Practice Address - Phone:718-934-8435
Practice Address - Fax:718-934-5931
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01873014Medicaid
NY42C831Medicare PIN
NY01873014Medicaid