Provider Demographics
NPI:1659017234
Name:MERCADO, IVAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:JOSEPH
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3808
Mailing Address - Country:US
Mailing Address - Phone:201-418-1000
Mailing Address - Fax:
Practice Address - Street 1:122 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2502
Practice Address - Country:US
Practice Address - Phone:201-418-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program