Basic Information
Provider Information
NPI: 1144322470
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MESHBERG
FirstName: PHILLIPS
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 32 SHORT HILL RD
Address2:  
City: NEW CITY
State: NY
PostalCode: 109561811
CountryCode: US
TelephoneNumber: 8456380884
FaxNumber:  
Practice Location
Address1: 138 ALBANY POST RD
Address2: VA HCS (FDR) HOSPITAL
City: MONTROSE
State: NY
PostalCode: 10548
CountryCode: US
TelephoneNumber: 9147374400
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835P1200X021997NYY Pharmacy Service ProvidersPharmacistPharmacotherapy

No ID Information.


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