Provider Demographics
NPI:1790731818
Name:BANIA, MERITA A (MD)
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:A
Last Name:BANIA
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 1:404 E 76TH ST
Mailing Address - Street 2:APT 10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1400
Mailing Address - Country:US
Mailing Address - Phone:212-861-2169
Mailing Address - Fax:
Practice Address - Street 1:11614 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1748
Practice Address - Country:US
Practice Address - Phone:718-846-0606
Practice Address - Fax:718-846-8684
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4767982085R0202X
IN01091382A2085R0202X
NY1910792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01864093Medicaid
NY01864093Medicaid
G75364Medicare UPIN