Healthcare Provider Details

I. General information

NPI: 1790731818
Provider Name (Legal Business Name): MERITA A BANIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11614 MYRTLE AVE
RICHMOND HILL NY
11418-1748
US

IV. Provider business mailing address

404 E 76TH ST APT 10B
NEW YORK NY
10021-1400
US

V. Phone/Fax

Practice location:
  • Phone: 718-846-0606
  • Fax: 718-846-8684
Mailing address:
  • Phone: 212-861-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD476798
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01091382A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number191079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: