Healthcare Provider Details

I. General information

NPI: 1992067789
Provider Name (Legal Business Name): MS. JODI P MAYERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR ST
NEW ROCHELLE NY
10801-5247
US

IV. Provider business mailing address

20 CEDAR ST
NEW ROCHELLE NY
10801-5247
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1207812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: