Provider Demographics
NPI:1265879605
Name:MEINBACH, EDITH DITTA (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:DITTA
Last Name:MEINBACH
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 1:10007 67TH DR
Mailing Address - Street 2:1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3146
Mailing Address - Country:US
Mailing Address - Phone:718-997-8595
Mailing Address - Fax:
Practice Address - Street 1:10007 67TH DR
Practice Address - Street 2:1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11375-3146
Practice Address - Country:US
Practice Address - Phone:718-997-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087509-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY087509-1OtherPHYSICIAN