Healthcare Provider Details

I. General information

NPI: 1306809678
Provider Name (Legal Business Name): DONALD J MYERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD CENTRAL PARK EAST
LINWOOD NJ
08221-1299
US

IV. Provider business mailing address

222 NEW RD CENTRAL PARK EAST
LINWOOD NJ
08221-1299
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-9790
  • Fax: 609-926-8796
Mailing address:
  • Phone: 609-927-9790
  • Fax: 609-926-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00147600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00147600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: