Healthcare Provider Details

I. General information

NPI: 1811233117
Provider Name (Legal Business Name): MEREDIAN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 PLEASANT VALLEY WAY SUITE 201
WEST ORANGE NJ
07052-2988
US

IV. Provider business mailing address

412 PLEASANT VALLEY WAY SUITE 201
WEST ORANGE NJ
07052-2988
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-9707
  • Fax:
Mailing address:
  • Phone: 973-731-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06715400
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA06715400
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA06715400
License Number State

VIII. Authorized Official

Name: DR. LILIYA YANOVSKAYA
Title or Position: PRESIDENT
Credential: MD
Phone: 973-731-9707