Provider Demographics
NPI:1891968152
Name:MEGNA, JOSE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARIA
Last Name:MEGNA
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 1:74 AVALON GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-7420
Mailing Address - Country:US
Mailing Address - Phone:845-406-3610
Mailing Address - Fax:
Practice Address - Street 1:74 AVALON GARDENS
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-7420
Practice Address - Country:US
Practice Address - Phone:845-406-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1427123496Medicaid
CA1427123496Medicaid