Provider Demographics
NPI:1578260808
Name:MERCEDES, NATALIE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MERCEDES
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 1:45 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1710
Mailing Address - Country:US
Mailing Address - Phone:347-216-3270
Mailing Address - Fax:
Practice Address - Street 1:238 SPRING ST STE A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2115
Practice Address - Country:US
Practice Address - Phone:973-862-6650
Practice Address - Fax:973-862-6655
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant