Provider Demographics
NPI:1639194996
Name:MEYER, ADOLPH B (MD)
Entity Type:Individual
Prefix:
First Name:ADOLPH
Middle Name:B
Last Name:MEYER
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 1:639 SINCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2643
Mailing Address - Country:US
Mailing Address - Phone:718-966-7940
Mailing Address - Fax:
Practice Address - Street 1:639 SINCLAIR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2643
Practice Address - Country:US
Practice Address - Phone:718-966-7940
Practice Address - Fax:718-966-4382
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation