Provider Demographics
NPI:1962775098
Name:DECKER, MEGHAN ELIZABETH (NP)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:DECKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E 75TH ST
Mailing Address - Street 2:APT 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3127
Mailing Address - Country:US
Mailing Address - Phone:908-447-7459
Mailing Address - Fax:
Practice Address - Street 1:411 E 75TH ST
Practice Address - Street 2:APT 7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3127
Practice Address - Country:US
Practice Address - Phone:908-447-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305499-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health