Healthcare Provider Details

I. General information

NPI: 1962445700
Provider Name (Legal Business Name): MICHELLE S MAYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CHESTNUT RIDGE RD SUITE 1120
MONTVALE NJ
07645
US

IV. Provider business mailing address

135 CHESTNUT RIDGE RD SUITE 1120
MONTVALE NJ
07645
US

V. Phone/Fax

Practice location:
  • Phone: 201-391-2020
  • Fax: 201-391-0265
Mailing address:
  • Phone: 201-391-2020
  • Fax: 201-391-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07744500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: