Healthcare Provider Details

I. General information

NPI: 1982600219
Provider Name (Legal Business Name): JAY MEISNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 PARK AVE STE 1B
NEW YORK NY
10065-7016
US

IV. Provider business mailing address

605 PARK AVE STE 1B
NEW YORK NY
10065-7016
US

V. Phone/Fax

Practice location:
  • Phone: 212-794-1500
  • Fax: 212-794-8760
Mailing address:
  • Phone: 212-794-1500
  • Fax: 212-794-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number160821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: