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General NPI Number Information
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NPI Number | 1770597395
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Entity Type | Organization
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Legal Business Name | MERCY MEDICAL CENTER
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 N. VILLAGE AVENUE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11571
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Country | US
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Telephone | 516-705-1353
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Fax |
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Provider Business Mailing Address
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Address Line | P.O BOX 798
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570
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Country | US
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Telephone | 516-705-1353
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Fax |
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Authorized Official
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Title or Position | CREDENTIALS DIRECTOR
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Name | JACQUELINE BRATHWAITE
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Credential |
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Telephone | 516-705-1353
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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 |
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License Number State |
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