Provider Demographics
NPI:1619024122
Name:MERCADO, CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LIVINGSTON ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1738
Mailing Address - Country:US
Mailing Address - Phone:201-564-7515
Mailing Address - Fax:201-564-7514
Practice Address - Street 1:220 LIVINGSTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1738
Practice Address - Country:US
Practice Address - Phone:201-564-7515
Practice Address - Fax:201-564-7514
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01197600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ271878734OtherTIN