MEDICARE: DR. DEBRA MAYER MESNICK M.D.

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	208000000X	Pediatrics Physician	225793	NY

General Provider Information

NPI Number	:	1407832835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA MAYER MESNICK M.D.

Provider Business Mailing Address
First Line	:	330 E 80TH ST
Second Line	:	APT 2 C
City	:	NEW YORK
State	:	NY
Zip	:	10021-0915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 GRAMATAN AVE
Second Line	:	STE 203
City	:	MT VERNON
State	:	NY
Zip	:	10552-2155
Country	:	US
Telephone Number	:	914-663-0151
Fax Number	:	914-663-0154

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

Provider Enumeration Date	:	12/18/2005
Last Update Date	:	02/26/2021

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