Provider Demographics
NPI:1124205232
Name:ARLENE B. MERCADO, M.D.
Entity Type:Organization
Organization Name:ARLENE B. MERCADO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERCADO-CAPISTRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-271-0455
Mailing Address - Street 1:8824 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3947
Mailing Address - Country:US
Mailing Address - Phone:718-271-0455
Mailing Address - Fax:718-271-0454
Practice Address - Street 1:8824 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3947
Practice Address - Country:US
Practice Address - Phone:718-271-0455
Practice Address - Fax:718-271-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231220-1261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty