MEDICARE: MRS. BRENDA MEREDITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician	056	NJ

General Provider Information

NPI Number	:	1548961634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA MEREDITH

Provider Business Mailing Address
First Line	:	550 UNION AVE STE 4
Second Line	:
City	:	MIDDLESEX
State	:	NJ
Zip	:	08846-1949
Country	:	US
Telephone Number	:	732-925-0542
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 UNION AVE STE 4
Second Line	:
City	:	MIDDLESEX
State	:	NJ
Zip	:	08846-1949
Country	:	US
Telephone Number	:	732-925-0542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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Directions to “ MRS. BRENDA MEREDITH ” Practice Location

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