Healthcare Provider Details

I. General information

NPI: 1609925585
Provider Name (Legal Business Name): MERA DJOKIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

4 ARDEN DR
AMAWALK NY
10501-1023
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-2061
  • Fax: 212-562-2991
Mailing address:
  • Phone: 914-243-9103
  • Fax: 212-562-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: