Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC006928 | PA |
Y | 222Z00000X | Podiatrist | SC006928 | PA |
N | 213EP0504X | Public Medicine | SC006928 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC006928 | PA |
N | 111NR0200X | Radiology | SC006928 | PA |
N | 213ER0200X | Radiology | SC006928 | PA |
N | 2081S0010X | Sports Medicine | SC006928 | PA |
N | 213ES0000X | Sports Medicine | SC006928 | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC006928 | PA |
NPI | 1851877179 |
---|---|
Provider Name | Andrew Mermelstein |
First Address | Huntingdon Valley, PA 19006-2224 |
Second Address | Philadelphia, PA 19128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 19/07/2018 |