Provider Demographics
NPI:1588105910
Name:ROBERT MMEREOLE,LLC
Entity type:Organization
Organization Name:ROBERT MMEREOLE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MMEREOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:714-366-2581
Mailing Address - Street 1:6101 KENNEDY BLVD E
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3902
Mailing Address - Country:US
Mailing Address - Phone:714-366-2581
Mailing Address - Fax:
Practice Address - Street 1:6101 KENNEDY BLVD E
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-3902
Practice Address - Country:US
Practice Address - Phone:714-366-2581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00504700363LP0200X
NJ25MA09692300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty