Healthcare Provider Details

I. General information

NPI: 1467892752
Provider Name (Legal Business Name): MEGAN J KERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PARK STREET
MONTCLAIR NJ
07042
US

IV. Provider business mailing address

51 PARK STREET
MONTCLAIR NJ
07042
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-6900
  • Fax: 973-509-6939
Mailing address:
  • Phone: 973-509-6900
  • Fax: 973-509-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00308000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: