Provider Demographics
NPI:1578640520
Name:KINGS COUNTY HOSPITAL CENTER
Entity Type:Organization
Organization Name:KINGS COUNTY HOSPITAL CENTER
Other - Org Name:NICOLA MERTSARIS MEDICAL DOCTOR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTSARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:718-626-7029
Mailing Address - Street 1:4016 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4016 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3400
Practice Address - Country:US
Practice Address - Phone:718-626-7029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133950282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access