Provider Demographics
NPI:1619957404
Name:MEYEROVICH, INESSA (MD)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:MEYEROVICH
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 1:764 PLAINFIELD LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3607
Mailing Address - Country:US
Mailing Address - Phone:516-791-1727
Mailing Address - Fax:
Practice Address - Street 1:9811 QUEENS BLVD
Practice Address - Street 2:SUITE 1E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3323
Practice Address - Country:US
Practice Address - Phone:718-830-0400
Practice Address - Fax:718-830-0005
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2187702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04943GMedicare ID - Type Unspecified
NYH49901Medicare UPIN