Provider Demographics
NPI:1538102843
Name:MERMELSTEIN, ERWIN (MD)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 CRANBURY ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-3333
Mailing Address - Fax:732-390-9244
Practice Address - Street 1:593 CRANBURY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-390-3333
Practice Address - Fax:732-390-9244
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04203400207RC0000X
NJ25MA04203400207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ574210Medicare PIN
C63252Medicare UPIN
NJ574210YKYAMedicare PIN