Provider Demographics
NPI:1275516205
Name:MERMELSTEIN, STEVE A (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:A
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MERRICK RD
Mailing Address - Street 2:LOWER LEVEL 1
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-593-9500
Mailing Address - Fax:516-593-9048
Practice Address - Street 1:444 MERRICK RD
Practice Address - Street 2:LOWER LEVEL 1
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-593-9500
Practice Address - Fax:516-593-9048
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY135543207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00697796Medicaid
66A941Medicare ID - Type Unspecified
B17667Medicare UPIN