Provider Demographics
NPI:1407101215
Name:GEORGE, MERIN
Entity Type:Individual
Prefix:MRS
First Name:MERIN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15J BLUE HILL COMMONS
Mailing Address - Street 2:J
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2135
Mailing Address - Country:US
Mailing Address - Phone:914-420-0976
Mailing Address - Fax:
Practice Address - Street 1:15J BLUE HILL COMMONS
Practice Address - Street 2:J
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2135
Practice Address - Country:US
Practice Address - Phone:914-420-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304637164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse