Healthcare Provider Details

I. General information

NPI: 1003677188
Provider Name (Legal Business Name): MERAHEM TAMAR EUGENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16937 144TH RD
JAMAICA NY
11434-5929
US

IV. Provider business mailing address

407 BEACH 20TH ST APT 2L
FAR ROCKAWAY NY
11691-3638
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-7221
  • Fax: 718-978-0032
Mailing address:
  • Phone: 347-424-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number349283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: