Provider Demographics
NPI:1891963963
Name:MERCURIO, GARY ANGELO (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANGELO
Last Name:MERCURIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3008
Mailing Address - Country:US
Mailing Address - Phone:845-633-6300
Mailing Address - Fax:
Practice Address - Street 1:110 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3008
Practice Address - Country:US
Practice Address - Phone:845-633-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0118351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor