Healthcare Provider Details

I. General information

NPI: 1104097294
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N. VILLAGE AVENUE
ROCKVILLE CENTRE NY
11571
US

IV. Provider business mailing address

P.O. BOX 798
ROCKVILLE CENTRE NY
11571
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-1353
  • Fax: 516-705-3575
Mailing address:
  • Phone: 516-705-1353
  • Fax: 516-705-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number178140
License Number StateNY

VIII. Authorized Official

Name: JOHN REILLY
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 516-705-1353