Provider Demographics
NPI:1629721352
Name:MERCADO, JAVIER (CRPA)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SURF DR # PD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2491
Mailing Address - Country:US
Mailing Address - Phone:347-352-2435
Mailing Address - Fax:917-473-6306
Practice Address - Street 1:754 E 151ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3267
Practice Address - Country:US
Practice Address - Phone:929-342-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-5018175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist