Provider Demographics
NPI:1811087687
Name:MERCY OB/GYN , PC
Entity type:Organization
Organization Name:MERCY OB/GYN , PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-920-9647
Mailing Address - Street 1:600 E 233RD ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2604
Mailing Address - Country:US
Mailing Address - Phone:718-920-9647
Mailing Address - Fax:718-920-9095
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9647
Practice Address - Fax:718-920-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMEOWX10220Medicare ID - Type Unspecified