Healthcare Provider Details

I. General information

NPI: 1770567166
Provider Name (Legal Business Name): JAY MERMELSTEIN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 STEVENS AVE STE 301
MOUNT VERNON NY
10550-2686
US

IV. Provider business mailing address

105 STEVENS AVE STE 301
MOUNT VERNON NY
10550-2686
US

V. Phone/Fax

Practice location:
  • Phone: 914-699-1515
  • Fax: 914-699-2907
Mailing address:
  • Phone: 914-699-1515
  • Fax: 914-699-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004414
License Number StateNY

VIII. Authorized Official

Name: JAY MERMELSTEIN
Title or Position: OWNER PRESIDENT
Credential: DPM
Phone: 914-699-1515