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General NPI Number Information
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NPI Number | 1174643654
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Entity Type | Individual
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Provider Name | MERSON SAMUEL NP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 119 FULTON AVE
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City | GARDEN CITY PARK
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State | NY
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Zip | 11040
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Country | US
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Telephone | 516-877-8052
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Fax |
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Provider Business Mailing Address
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Address Line | 972 BRUSH HOLLOW RD
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City | WESTBURY
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State | NY
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Zip | 11590-1740
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Country | US
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Telephone | 516-876-5555
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Fax | 516-876-1246
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 431164
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F303651
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License Number State | NY
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