Healthcare Provider Details

I. General information

NPI: 1831362326
Provider Name (Legal Business Name): JOSEPH RODRIGO MEJIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 WATCHUNG AVE
WATCHUNG NJ
07069-4945
US

IV. Provider business mailing address

124 THANKSGIVING LN
CLIFTON NJ
07013-2540
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-2424
  • Fax:
Mailing address:
  • Phone: 718-598-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB08556200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: