Provider Demographics
NPI:1679646129
Name:MEIMARIS, DEMETRI G (DC)
Entity Type:Individual
Prefix:DR
First Name:DEMETRI
Middle Name:G
Last Name:MEIMARIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 N MAPLE AVE
Mailing Address - Street 2:#293
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3212
Mailing Address - Country:US
Mailing Address - Phone:201-843-8002
Mailing Address - Fax:201-843-8834
Practice Address - Street 1:444 MARKET ST
Practice Address - Street 2:#3
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5996
Practice Address - Country:US
Practice Address - Phone:201-843-8002
Practice Address - Fax:201-843-8834
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00278700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ456717UWVMedicare ID - Type UnspecifiedMEDICARE ID NUMBER