Healthcare Provider Details

I. General information

NPI: 1619681558
Provider Name (Legal Business Name): MERVILUS-BIGORD NP IN FAMILY HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 VANDERBILT AVE
STATEN ISLAND NY
10304-2604
US

IV. Provider business mailing address

333 DRAKE AVE
ROSELLE NJ
07203-1413
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0701
  • Fax:
Mailing address:
  • Phone: 347-881-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA MERVILUS-BIGORD
Title or Position: CEO
Credential: NP
Phone: 347-881-5586