Healthcare Provider Details

I. General information

NPI: 1285676171
Provider Name (Legal Business Name): NEAL IRA MERMELSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7439 FRANKFORD AVE
PHILADELPHIA PA
19136-3632
US

IV. Provider business mailing address

7439 FRANKFORD AVE
PHILADELPHIA PA
19136-3632
US

V. Phone/Fax

Practice location:
  • Phone: 215-333-9484
  • Fax: 215-333-7739
Mailing address:
  • Phone: 215-333-9484
  • Fax: 215-333-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS005880L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: