MEDICARE: JOSEPH ALPHONSE MEROLA PA

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	363AM0700X	Medical Physician Assistant	007463	NY
2	363A00000X	Physician Assistant	007463-1	NY

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	:	1194786277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ALPHONSE MEROLA PA

Provider Business Mailing Address
First Line	:	304 GENESEE ST
Second Line	:
City	:	CHITTENANGO
State	:	NY
Zip	:	13037-1707
Country	:	US
Telephone Number	:	315-687-6467
Fax Number	:	315-251-2240

Provider Business Practice Location Address
First Line	:	3709 ERIE BLVD
Second Line	:
City	:	DEWITT
State	:	NY
Zip	:	13214-2227
Country	:	US
Telephone Number	:	315-251-2244
Fax Number	:	315-251-2240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	03/15/2017

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