=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831362326
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH RODRIGO MEJIA D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2008
-----------------------------------------------------
Last Update Date | 06/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 WATCHUNG AVE
-----------------------------------------------------
City | WATCHUNG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07069-4945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-756-2424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 THANKSGIVING LN
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-2540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-598-1107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 25MB08556200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------