Healthcare Provider Details

I. General information

NPI: 1487636726
Provider Name (Legal Business Name): MERVIN GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LIVINGSTON AVE UNIT 401
NEW BRUNSWICK NJ
08901-1991
US

IV. Provider business mailing address

20 LIVINGSTON AVE UNIT 401
NEW BRUNSWICK NJ
08901-1991
US

V. Phone/Fax

Practice location:
  • Phone: 917-881-1223
  • Fax:
Mailing address:
  • Phone: 917-881-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number174172
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number174172
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number213359
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA08065400
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number174172
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00024696
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: