Healthcare Provider Details

I. General information

NPI: 1780146001
Provider Name (Legal Business Name): JAVIER ORLANDO MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAVIER ORLANDO MEJIA GABALDON MD

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

7901 35TH AVE APT 1B
JACKSON HEIGHTS NY
11372-2715
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 718-424-7831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number335310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: