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General NPI Number Information
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NPI Number | 1902763105
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Entity Type | Individual
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Provider Name | CLEEVON C MERCURIUS
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Gender | Male
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 322 BIRCH RD
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City | MAHOPAC
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State | NY
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Zip | 10541-1104
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Country | US
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Telephone | 914-258-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 322 BIRCH RD
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City | MAHOPAC
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State | NY
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Zip | 10541-1104
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Country | US
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Telephone | 914-258-2618
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 930180-01
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License Number State | NY
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