Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N003270 | NY |
NPI | 1073533113 |
---|---|
Provider Name | Mr. Steven Mermelstein |
First Address | Astoria, NY 11105-2305 |
Second Address | Astoria, NY 11105-2305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 25/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00637169 | (05) | NY |
480010583 | MEDICARE RAILROAD (01) | NY |
55369I | MEDICARE GHI (01) | NY |
T92854 | (02) | NY |