Provider Demographics
NPI:1225076144
Name:MAYFAIR PROFESSIONAL OFFICE, PC
Entity Type:Organization
Organization Name:MAYFAIR PROFESSIONAL OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:MERMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-333-9484
Mailing Address - Street 1:7439 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3632
Mailing Address - Country:US
Mailing Address - Phone:215-333-9484
Mailing Address - Fax:215-333-7739
Practice Address - Street 1:7439 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3632
Practice Address - Country:US
Practice Address - Phone:215-333-9484
Practice Address - Fax:215-333-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA024319Medicare ID - Type Unspecified