Provider Demographics
NPI:1942589817
Name:J.C. MEEROFF MD PA
Entity Type:Organization
Organization Name:J.C. MEEROFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-771-9297
Mailing Address - Street 1:4801 N FEDERAL HWY
Mailing Address - Street 2:SUITE 202 EAST
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4618
Mailing Address - Country:US
Mailing Address - Phone:954-771-9297
Mailing Address - Fax:954-771-9913
Practice Address - Street 1:4801 N FEDERAL HWY
Practice Address - Street 2:SUITE 202 EAST
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4618
Practice Address - Country:US
Practice Address - Phone:954-771-9297
Practice Address - Fax:954-771-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041305207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372960500Medicaid
FL372960500Medicaid