MEDICARE: DR. ERROL MEISNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA20147	NJ

General Provider Information

NPI Number	:	1023000874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERROL MEISNER MD

Provider Business Mailing Address
First Line	:	77 BRANT AVE
Second Line	:	SUITE 200
City	:	CLARK
State	:	NJ
Zip	:	07066-1560
Country	:	US
Telephone Number	:	732-382-0091
Fax Number	:	732-382-8570

Provider Business Practice Location Address
First Line	:	425 ESSEX ST
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1316
Country	:	US
Telephone Number	:	973-467-0866
Fax Number	:	973-467-5485

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/20/2011

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