Provider Demographics
NPI:1609809805
Name:MERCY HOME CARE & MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:MERCY HOME CARE & MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-896-0001
Mailing Address - Street 1:456 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:E RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1315
Mailing Address - Country:US
Mailing Address - Phone:201-896-0001
Mailing Address - Fax:201-896-9467
Practice Address - Street 1:456 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:E RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1315
Practice Address - Country:US
Practice Address - Phone:201-896-0001
Practice Address - Fax:201-896-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7009305332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02382589Medicaid
NJ7009305Medicaid
NY02382589Medicaid