Provider Demographics
NPI:1477704948
Name:OUR LADY OF MERCY AMBULATORY CARE CENTER, INC.
Entity Type:Organization
Organization Name:OUR LADY OF MERCY AMBULATORY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-920-1642
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-0263
Mailing Address - Country:US
Mailing Address - Phone:718-920-1642
Mailing Address - Fax:
Practice Address - Street 1:4234 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2611
Practice Address - Country:US
Practice Address - Phone:347-341-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005547261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377219Medicaid
NYZH0PB0541Medicare PIN
NYU75283Medicare UPIN