Provider Demographics
NPI:1700919297
Name:MERRILL, MICHELLE BENGER (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:BENGER
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W 75TH ST
Mailing Address - Street 2:SUITE 1R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1835
Mailing Address - Country:US
Mailing Address - Phone:212-595-4555
Mailing Address - Fax:
Practice Address - Street 1:135 W 75TH ST
Practice Address - Street 2:SUITE 1R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1835
Practice Address - Country:US
Practice Address - Phone:212-595-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2330582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry