Healthcare Provider Details

I. General information

NPI: 1487737599
Provider Name (Legal Business Name): ARTHUR J MEROLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RALPH PL STE 314
STATEN ISLAND NY
10304-4420
US

IV. Provider business mailing address

139 GARFIELD AVE
STATEN ISLAND NY
10305-3710
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-8040
  • Fax: 718-448-8041
Mailing address:
  • Phone: 800-741-5273
  • Fax: 718-448-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberNOO4960-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNOO4960-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: