Healthcare Provider Details

I. General information

NPI: 1548282502
Provider Name (Legal Business Name): DON MERCADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 ANDERSON AVE SUITE 201
CLIFFSIDE PARK NJ
07010-1831
US

IV. Provider business mailing address

PO BOX 1986
CLIFFSIDE PARK NJ
07010-5986
US

V. Phone/Fax

Practice location:
  • Phone: 201-923-9041
  • Fax: 201-941-1553
Mailing address:
  • Phone: 201-923-9041
  • Fax: 201-941-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberY27779
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DON MERCADO
Title or Position: OWNER
Credential: PULMONARY TECH
Phone: 201-923-9041