Provider Demographics
NPI:1013920933
Name:MEYER, PATRICIA B (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:B
Last Name:MEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-941-1388
Mailing Address - Fax:631-689-3993
Practice Address - Street 1:1212 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-941-1388
Practice Address - Fax:631-689-3993
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4001711363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY93N671Medicare ID - Type Unspecified
S98255Medicare UPIN
NY93N672Medicare ID - Type Unspecified