Healthcare Provider Details

I. General information

NPI: 1376603118
Provider Name (Legal Business Name): ERENIO MEJIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WESTFIELD AVE
ELIZABETH NJ
07208-1622
US

IV. Provider business mailing address

505 WESTFIELD AVE
ELIZABETH NJ
07208-1622
US

V. Phone/Fax

Practice location:
  • Phone: 908-354-5461
  • Fax: 908-354-5462
Mailing address:
  • Phone: 908-354-5461
  • Fax: 908-354-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03870300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: