1174111215 NPI number — MRS. PAT EMILIE MERECIDO POLIMENI FNP

Table of content: MRS. PAT EMILIE MERECIDO POLIMENI FNP (NPI 1174111215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174111215 NPI number — MRS. PAT EMILIE MERECIDO POLIMENI FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLIMENI
Provider First Name:
PAT EMILIE
Provider Middle Name:
MERECIDO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERECIDO
Provider Other First Name:
PAT EMILIE
Provider Other Middle Name:
DAGPIN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174111215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4256 BRONX BLVD STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10466-2673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-515-4347
Provider Business Mailing Address Fax Number:
718-653-8641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4256 BRONX BLVD STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466-2673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-515-4347
Provider Business Practice Location Address Fax Number:
718-653-8641
Provider Enumeration Date:
01/05/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F347076 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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