Provider Demographics
NPI:1013947837
Name:MERCOVICH, AMY P (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:P
Last Name:MERCOVICH
Suffix:
Gender:F
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:BERGEN
Mailing Address - State:NY
Mailing Address - Zip Code:14416
Mailing Address - Country:US
Mailing Address - Phone:585-494-2870
Mailing Address - Fax:585-494-2260
Practice Address - Street 1:45 N LAKE ST
Practice Address - Street 2:
Practice Address - City:BERGEN
Practice Address - State:NY
Practice Address - Zip Code:14416
Practice Address - Country:US
Practice Address - Phone:585-494-2870
Practice Address - Fax:585-494-2260
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5752802OtherAETNA
NYP010008349OtherBLUE CROSS BLUE SHIELD
U63754Medicare UPIN
14279BMedicare ID - Type Unspecified