Healthcare Provider Details

I. General information

NPI: 1194786277
Provider Name (Legal Business Name): JOSEPH ALPHONSE MEROLA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 ERIE BLVD
DEWITT NY
13214-2227
US

IV. Provider business mailing address

304 GENESEE ST
CHITTENANGO NY
13037-1707
US

V. Phone/Fax

Practice location:
  • Phone: 315-251-2244
  • Fax: 315-251-2240
Mailing address:
  • Phone: 315-687-6467
  • Fax: 315-251-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007463
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007463-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: