1538160395 NPI number — DR. KENNETH A MERCER MD MPH

Table of content: DR. KENNETH A MERCER MD MPH (NPI 1538160395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538160395 NPI number — DR. KENNETH A MERCER MD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCER
Provider First Name:
KENNETH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD MPH
Provider Gender Code:
M

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:
1538160395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 INDEPENDENCE AVE
Provider Second Line Business Mailing Address:
APT 1M
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10463-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-853-0953
Provider Business Mailing Address Fax Number:
718-853-0953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-684-6684
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2005

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: 207RG0300X , with the licence number:  210817 , 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)

  • Identifier: 01893012 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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