Provider Demographics
NPI:1407845142
Name:MEYERBERG, BRIAN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MEYERBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LACEY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2912
Mailing Address - Country:US
Mailing Address - Phone:732-849-1115
Mailing Address - Fax:732-849-1064
Practice Address - Street 1:67 LACEY RD STE 2
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2912
Practice Address - Country:US
Practice Address - Phone:732-849-1115
Practice Address - Fax:732-849-1064
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002137213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ480018620OtherPALMETTO GBA RAILROAD
NJ5614805Medicaid
NJ5614805Medicaid
NJ4405340001Medicare NSC
NJ480018620OtherPALMETTO GBA RAILROAD