Healthcare Provider Details

I. General information

NPI: 1336130210
Provider Name (Legal Business Name): NONNA MEGRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 ATLANTIC AVE
BROOKLYN NY
11217-1985
US

IV. Provider business mailing address

102-50 62ND RD APT 4S
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-875-1167
  • Fax: 718-875-2350
Mailing address:
  • Phone: 718-699-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: