Provider Demographics
NPI:1073533113
Name:MERMELSTEIN, STEVEN (DPM)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 DITMARS BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2305
Mailing Address - Country:US
Mailing Address - Phone:718-274-4040
Mailing Address - Fax:718-726-6414
Practice Address - Street 1:3117 DITMARS BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2305
Practice Address - Country:US
Practice Address - Phone:718-274-4040
Practice Address - Fax:718-726-6414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003270213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00637169Medicaid
NY55369IOtherMEDICARE GHI
NY480010583OtherMEDICARE RAILROAD
NY55369IOtherMEDICARE GHI