Healthcare Provider Details

I. General information

NPI: 1750461323
Provider Name (Legal Business Name): JOSE ORLANDO MEJIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

7901 35TH AVE APT. 1B
JACKSON HEIGHTS NY
11372-2741
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-5811
  • Fax: 718-963-8753
Mailing address:
  • Phone: 718-963-5811
  • Fax: 718-963-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number170994
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: