Provider Demographics
NPI:1144230020
Name:MERTZ, MELITA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELITA
Middle Name:J
Last Name:MERTZ
Suffix:
Gender:F
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:PO BOX 399
Mailing Address - Street 2:52 1/2 NORTH ST
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053
Mailing Address - Country:US
Mailing Address - Phone:604-844-9699
Mailing Address - Fax:607-844-3710
Practice Address - Street 1:52 1/2 NORTH ST
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:604-844-9699
Practice Address - Fax:607-844-3710
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004652213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01515291Medicaid
NY5419020001Medicare NSC
NY52176BMedicare ID - Type Unspecified
NYU17925Medicare UPIN