Provider Demographics
NPI:1952671653
Name:DR. HENRY N MERRITT JR PA
Entity Type:Organization
Organization Name:DR. HENRY N MERRITT JR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:954-791-7474
Mailing Address - Street 1:1160 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6630
Mailing Address - Country:US
Mailing Address - Phone:954-791-7474
Mailing Address - Fax:954-791-5807
Practice Address - Street 1:1160 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-6630
Practice Address - Country:US
Practice Address - Phone:954-791-7474
Practice Address - Fax:954-791-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO385213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84628Medicare UPIN
FL87194Medicare PIN