Healthcare Provider Details

I. General information

NPI: 1376037564
Provider Name (Legal Business Name): NATHAN H MERHCANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WHEATFIELD ST STE 25
NORTH TONAWANDA NY
14120-7034
US

IV. Provider business mailing address

525 WHEATFIELD ST STE 25
NORTH TONAWANDA NY
14120-7034
US

V. Phone/Fax

Practice location:
  • Phone: 716-423-2323
  • Fax: 716-535-1001
Mailing address:
  • Phone: 716-423-2323
  • Fax: 716-535-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number04710927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: