Provider Demographics
NPI:1538306212
Name:JAY MERMELSTEIN, DPM.PC
Entity Type:Organization
Organization Name:JAY MERMELSTEIN, DPM.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-699-1515
Mailing Address - Street 1:105 STEVENS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-699-1515
Mailing Address - Fax:914-699-2907
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-699-1515
Practice Address - Fax:914-699-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004414332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02606059Medicaid