Provider Demographics
NPI:1720090079
Name:MAINERO, MICHAEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:MAINERO
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 1:205 BROWERTOWN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2671
Mailing Address - Country:US
Mailing Address - Phone:973-785-0102
Mailing Address - Fax:973-785-2205
Practice Address - Street 1:205 BROWERTOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2671
Practice Address - Country:US
Practice Address - Phone:973-785-0102
Practice Address - Fax:973-785-2205
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ55027207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5510708Medicaid
NJ467633Medicare ID - Type Unspecified