Provider Demographics
NPI:1972591758
Name:MELLER, EDWARD PHILIP (DPM)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:PHILIP
Last Name:MELLER
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 1:921 BERGEN AVE
Mailing Address - Street 2:SUITE # 629
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4203
Mailing Address - Country:US
Mailing Address - Phone:201-659-2986
Mailing Address - Fax:201-217-1226
Practice Address - Street 1:921 BERGEN AVE
Practice Address - Street 2:SUITE # 629
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4203
Practice Address - Country:US
Practice Address - Phone:201-659-2986
Practice Address - Fax:201-217-1226
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002458213E00000X
NYN005344213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03180OtherGHI MEDICARE
NJ8473005Medicaid
NJ046801OtherEMPIRE MEDICARE
NY03180OtherGHI MEDICARE
NJ8473005Medicaid