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General NPI Number Information
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NPI Number | 1275720922
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Entity Type | Individual
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Provider Name | JAY MERMELSTEIN DPM
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 105 STEVENS AVE SUITE 301
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2686
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Country | US
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Telephone | 914-699-1515
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Fax | 914-699-2907
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Provider Business Mailing Address
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Address Line | 105 STEVENS AVE SUITE 301
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2686
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Country | US
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Telephone | 914-699-1515
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Fax | 914-699-2907
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004414
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00251400
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License Number State | NJ
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