Healthcare Provider Details

I. General information

NPI: 1982602413
Provider Name (Legal Business Name): THOMAS MEOLA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BROADWAY RM 703
NEW YORK NY
10018-9365
US

IV. Provider business mailing address

1410 BROADWAY RM 703
NEW YORK NY
10018-9365
US

V. Phone/Fax

Practice location:
  • Phone: 212-481-7541
  • Fax: 212-599-4554
Mailing address:
  • Phone: 212-481-7541
  • Fax: 212-599-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number180823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: