Healthcare Provider Details

I. General information

NPI: 1093736878
Provider Name (Legal Business Name): MICHAEL B MAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 SPRINGFIELD AVE
WESTFIELD NJ
07090
US

IV. Provider business mailing address

150 FLORAL AVE
NEW PROVIDENCE NJ
07974-1557
US

V. Phone/Fax

Practice location:
  • Phone: 908-673-7251
  • Fax: 908-673-7265
Mailing address:
  • Phone: 908-273-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMA63564
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: