Healthcare Provider Details

I. General information

NPI: 1144292285
Provider Name (Legal Business Name): JOSEPHINE M MEW O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 LIBERTY AVE
BROOKLYN NY
11208-3310
US

IV. Provider business mailing address

3420 32ND ST APT. #3E
ASTORIA NY
11106-2760
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-7900
  • Fax: 718-235-7909
Mailing address:
  • Phone: 646-456-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: