Provider Demographics
NPI:1972257202
Name:MEME, PRISCILLE
Entity type:Individual
Prefix:
First Name:PRISCILLE
Middle Name:
Last Name:MEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MANOR DR APT 1N
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3244
Mailing Address - Country:US
Mailing Address - Phone:862-755-7820
Mailing Address - Fax:
Practice Address - Street 1:65 MANOR DR APT 1N
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3244
Practice Address - Country:US
Practice Address - Phone:862-755-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty