MEDICARE: RICHARD MERMELSTEIN MD

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	207R00000X	Internal Medicine Physician	290500	NY

General Provider Information

NPI Number	:	1629488440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MERMELSTEIN MD

Provider Business Mailing Address
First Line	:	1010 NORTHERN BLVD STE 328
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5329
Country	:	US
Telephone Number	:	516-233-2484
Fax Number	:	516-304-5850

Provider Business Practice Location Address
First Line	:	225 NASSAU BLVD # B
Second Line	:
City	:	W HEMPSTEAD
State	:	NY
Zip	:	11552-2247
Country	:	US
Telephone Number	:	516-656-1919
Fax Number	:	833-968-3330

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

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	09/10/2025

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