1508026477 NPI number — NEIL H MERKATZ, M.D. PA

Table of content: (NPI 1508026477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508026477 NPI number — NEIL H MERKATZ, M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL H MERKATZ, M.D. PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508026477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2563
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12325-0563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-384-1517
Provider Business Mailing Address Fax Number:
518-384-1358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 SE HILLMOOR DR
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952-7552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-335-9808
Provider Business Practice Location Address Fax Number:
772-335-9818
Provider Enumeration Date:
06/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
QUICK
Authorized Official First Name:
MARY-JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
772-384-1517

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME 68994 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: ME 68994 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 378915200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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