MEDICARE: MERMAID OPERATING CO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	207VG0400X	Gynecology Physician
3	207RN0300X	Nephrology Physician
4	208100000X	Physical Medicine & Rehabilitation Physician
5	213E00000X	Podiatrist
6	225100000X	Physical Therapist
7	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1053379362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERMAID OPERATING CO, LLC

Provider Business Mailing Address
First Line	:	1704 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2622
Country	:	US
Telephone Number	:	718-265-0900
Fax Number	:	718-265-6319

Provider Business Practice Location Address
First Line	:	1704 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2622
Country	:	US
Telephone Number	:	718-265-0900
Fax Number	:	718-265-6319

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CARLOS PEREZ
Credential	:	MD
Telephone Number	:	718-265-0900

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/05/2009

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