Provider Demographics
NPI:1437374840
Name:MERCER, JOANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
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:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:WATER MILL
Mailing Address - State:NY
Mailing Address - Zip Code:11976-0245
Mailing Address - Country:US
Mailing Address - Phone:917-535-2872
Mailing Address - Fax:
Practice Address - Street 1:708 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WATER MILL
Practice Address - State:NY
Practice Address - Zip Code:11976
Practice Address - Country:US
Practice Address - Phone:917-535-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04118-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP44441Medicare UPIN