Provider Demographics
NPI:1669615308
Name:MMEREOLE, ROBERT U (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:U
Last Name:MMEREOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6101 KENNEDY BLVD E
Mailing Address - Street 2:STE 1
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3902
Mailing Address - Country:US
Mailing Address - Phone:412-607-5450
Mailing Address - Fax:901-383-2245
Practice Address - Street 1:6101 KENNEDY BLVD E
Practice Address - Street 2:STE 1
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-3902
Practice Address - Country:US
Practice Address - Phone:412-607-5450
Practice Address - Fax:201-448-2804
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY257207207Q00000X
390200000X
NJ25M09692300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program