Organization
MIM MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA N METELITISIN MD (OWNER)
(201) 587-0380
Entity
Organization
Contact information
Practice address
11 MACKAY AVE, PARAMUS, NJ 07652-1273
(201) 587-0380
(201) 587-0384
Mailing address
13876 QUEENS BLVD, FIRST FLOOR, BRIARWOOD, NY 11435-2930
(718) 850-6345
(718) 559-4895
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA06616900
LICENSE NUMBER
NJ
Enumeration date
03/20/2008
Last updated
07/13/2009
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