Provider Demographics
NPI:1134412729
Name:MERMELSTEIN, KAREN (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MERMELSTEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3518
Mailing Address - Country:US
Mailing Address - Phone:516-526-2230
Mailing Address - Fax:
Practice Address - Street 1:714 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3518
Practice Address - Country:US
Practice Address - Phone:516-526-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant