Healthcare Provider Details

I. General information

NPI: 1144220047
Provider Name (Legal Business Name): ENRIQUE F MEJIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13110 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-3124
US

IV. Provider business mailing address

20622 WHITEHALL TER
QUEENS VILLAGE NY
11427-1721
US

V. Phone/Fax

Practice location:
  • Phone: 718-843-8844
  • Fax: 718-843-7681
Mailing address:
  • Phone: 718-843-8844
  • Fax: 718-843-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number152955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: