Provider Demographics
NPI:1619551637
Name:MERCY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:MERCY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANIK
Authorized Official - Middle Name:RAM
Authorized Official - Last Name:MANCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-475-2801
Mailing Address - Street 1:955 CONEY ISLAND AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1400
Mailing Address - Country:US
Mailing Address - Phone:347-475-2801
Mailing Address - Fax:
Practice Address - Street 1:2457 E MAIN ST UNIT 105
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2685
Practice Address - Country:US
Practice Address - Phone:347-475-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty