Provider Demographics
NPI:1376037564
Name:MERHCANT, NATHAN H
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:H
Last Name:MERHCANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WHEATFIELD ST STE 25
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7034
Mailing Address - Country:US
Mailing Address - Phone:716-423-2323
Mailing Address - Fax:716-535-1001
Practice Address - Street 1:525 WHEATFIELD ST STE 25
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-7034
Practice Address - Country:US
Practice Address - Phone:716-423-2323
Practice Address - Fax:716-535-1001
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04710927343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04710927Medicaid