Provider Demographics
NPI:1275720922
Name:MERMELSTEIN, JAY (DPM)
Entity Type:Individual
Prefix:
First Name:JAY
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 1:105 STEVENS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-699-1515
Mailing Address - Fax:914-699-2907
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-699-1515
Practice Address - Fax:914-699-2907
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004414213E00000X
NJ25MD00251400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01084459Medicaid
NY01084459Medicaid
NYP46001Medicare PIN
NY5699250001Medicare NSC