Basic Information
| Provider Information | |||||||||
| NPI: | 1922014190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYERS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LAUNDY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAUNDY | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | EASTON | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 164 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133469575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158244600 | ||||||||
| FaxNumber: | 3158248447 | ||||||||
| Practice Location | |||||||||
| Address1: | 164 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133469575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158244600 | ||||||||
| FaxNumber: | 3158248447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301078103 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 4301078103 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 02899232 | 05 | NY | MEDICAID | 4632435 | 05 | MI | MEDICAID |