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General NPI Number Information
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NPI Number | 1619681558
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Entity Type | Organization
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Legal Business Name | MERVILUS-BIGORD NP IN FAMILY HEALTH, P.C.
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 135 VANDERBILT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2604
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Country | US
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Telephone | 718-447-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 333 DRAKE AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-1413
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Country | US
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Telephone | 347-881-5586
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SANDRA MERVILUS-BIGORD
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Credential | NP
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Telephone | 347-881-5586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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