Provider Demographics
NPI:1790750859
Name:MEYEROVICH, NAUM (MD)
Entity Type:Individual
Prefix:
First Name:NAUM
Middle Name:
Last Name:MEYEROVICH
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 1:764 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:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02086771Medicaid
NY02086771Medicaid
NY19984Medicare UPIN