Healthcare Provider Details

I. General information

NPI: 1407625635
Provider Name (Legal Business Name): MERICARE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E 215TH ST
BRONX NY
10469-1307
US

IV. Provider business mailing address

1800 H ST NE
WASHINGTON DC
20002-4018
US

V. Phone/Fax

Practice location:
  • Phone: 646-671-2807
  • Fax:
Mailing address:
  • Phone: 646-671-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC CHO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 202-725-3281