MEDICARE: LA NUEVA MERCEDES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	28RS00328400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053412585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA NUEVA MERCEDES INC.

Provider Business Mailing Address
First Line	:	500 RIVER ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07524-1903
Country	:	US
Telephone Number	:	973-279-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RIVER ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07524-1903
Country	:	US
Telephone Number	:	973-279-2800
Fax Number	:	973-279-2197

Authorized Official
Title or Position	:	BILLER/MANAGER
Name	:	MISS BLANCA GONZALEZ
Credential	:
Telephone Number	:	973-279-2800

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	05/18/2010

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Directions to “LA NUEVA MERCEDES INC. ” Practice Location

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