Healthcare Provider Details

I. General information

NPI: 1508026477
Provider Name (Legal Business Name): NEIL H MERKATZ, M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SE HILLMOOR DR SUITE 17
PORT ST LUCIE FL
34952-7552
US

IV. Provider business mailing address

PO BOX 2563
GLENVILLE NY
12325-0563
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-9808
  • Fax: 772-335-9818
Mailing address:
  • Phone: 518-384-1517
  • Fax: 518-384-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 68994
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 68994
License Number StateFL

VIII. Authorized Official

Name: MS. MARY-JANE QUICK
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 772-384-1517