Provider Demographics
NPI:1972848307
Name:A MERRYLAND OPERATING LLC
Entity Type:Organization
Organization Name:A MERRYLAND OPERATING LLC
Other - Org Name:A MERRYLAND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIDIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESHCHINSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-265-0900
Mailing Address - Street 1:2873 W 17TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2611
Mailing Address - Country:US
Mailing Address - Phone:718-265-0900
Mailing Address - Fax:718-360-2279
Practice Address - Street 1:2873 W 17TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2611
Practice Address - Country:US
Practice Address - Phone:718-265-0900
Practice Address - Fax:718-360-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097912207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7001134ROtherOPERATING CERTIFICATE
NYC10935Medicare PIN