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General NPI Number Information
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NPI Number | 1962793273
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Entity Type | Organization
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Legal Business Name | MERMAID MANAGEMENT INC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 1704 06 MERMAID AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11224-2622
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Country | US
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Telephone | 718-265-0900
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Fax | 718-265-6319
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Provider Business Mailing Address
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Address Line | 170406 MERMAID AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11224-2622
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Country | US
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Telephone | 718-265-0900
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Fax | 718-265-6319
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ARMEN GAMBARIAN
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Credential |
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Telephone | 718-265-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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