Provider Demographics
NPI:1578646014
Name:MERMELSTEIN, LINDA KLEITMAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KLEITMAN
Last Name:MERMELSTEIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9006
Mailing Address - Street 2:SCDHS 3500 SUNRISE HIGHWAY, SUITE 124
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-9006
Mailing Address - Country:US
Mailing Address - Phone:631-854-0206
Mailing Address - Fax:
Practice Address - Street 1:SCDHS 3500 SUNRISE HIGHWAY
Practice Address - Street 2:SUITE 124
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-9006
Practice Address - Country:US
Practice Address - Phone:631-854-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169891208100000X, 2083P0901X
CAG57908208100000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE38795Medicare UPIN