Provider Demographics
NPI:1427576933
Name:MERMELSTEIN, STEPHANIE T
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:T
Last Name:MERMELSTEIN
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 1:235 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2453
Mailing Address - Country:US
Mailing Address - Phone:917-803-6369
Mailing Address - Fax:
Practice Address - Street 1:235 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2453
Practice Address - Country:US
Practice Address - Phone:917-803-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist