Provider Demographics
NPI:1922173350
Name:MERENSTEIN, MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MERENSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 FIELDSTON RD
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2034
Mailing Address - Country:US
Mailing Address - Phone:718-548-6732
Mailing Address - Fax:718-548-3819
Practice Address - Street 1:3636 FIELDSTON RD
Practice Address - Street 2:SUITE 1J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2034
Practice Address - Country:US
Practice Address - Phone:718-548-6732
Practice Address - Fax:718-548-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003955213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00954834Medicaid
NYP42021Medicare PIN
NY00954834Medicaid
NYP42022Medicare PIN