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General NPI Number Information
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NPI Number | 1619957404
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Entity Type | Individual
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Provider Name | INESSA MEYEROVICH M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9811 QUEENS BLVD SUITE 1E
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City | REGO PARK
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State | NY
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Zip | 11374-3323
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Country | US
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Telephone | 718-830-0400
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Fax | 718-830-0005
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Provider Business Mailing Address
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Address Line | 764 PLAINFIELD LN
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City | VALLEY STREAM
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State | NY
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Zip | 11581-3607
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Country | US
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Telephone | 516-791-1727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 218770
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License Number State | NY
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