Provider Demographics
NPI:1013911056
Name:MERCY HOME CARE & MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MERCY HOME CARE & MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:GREENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-376-3131
Mailing Address - Street 1:2001 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2818
Mailing Address - Country:US
Mailing Address - Phone:718-376-3131
Mailing Address - Fax:718-376-1411
Practice Address - Street 1:2001 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2818
Practice Address - Country:US
Practice Address - Phone:718-376-3131
Practice Address - Fax:718-376-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01450655Medicaid
NY0631180001Medicare ID - Type Unspecified