Provider Demographics
NPI:1174359194
Name:MERITT, JOSEPH DANIEL JR (CRPA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:MERITT
Suffix:JR
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3307
Mailing Address - Country:US
Mailing Address - Phone:917-618-0689
Mailing Address - Fax:
Practice Address - Street 1:1041 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3307
Practice Address - Country:US
Practice Address - Phone:917-618-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist