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General NPI Number Information
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NPI Number | 1417443151
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Entity Type | Individual
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Provider Name | KONSTANTIN MERGOLD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 120 E 16TH ST FL 6
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City | NEW YORK
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State | NY
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Zip | 10003-2162
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Country | US
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Telephone | 800-881-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 CROPSEY AVE APT 6K
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City | BROOKLYN
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State | NY
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Zip | 11214-6721
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 342597
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License Number State | NY
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