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General NPI Number Information
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NPI Number | 1578220455
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Entity Type | Individual
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Provider Name | MATTHEW MERENSKY PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 4 SMITH HAVEN MALL STE 103
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City | LAKE GROVE
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State | NY
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Zip | 11755-1219
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Country | US
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Telephone | 631-444-4233
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Fax | 631-444-4217
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Provider Business Mailing Address
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Address Line | 4 SMITH HAVEN MALL STE 103
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City | LAKE GROVE
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State | NY
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Zip | 11755-1219
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Country | US
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Telephone | 631-444-4233
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Fax | 631-444-4217
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 030424-01
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License Number State | NY
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