Basic Information
| Provider Information | |||||||||
| NPI: | 1427050277 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MERCADO | ||||||||
| FirstName: | MYRA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 SAW MILL RIVER RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105321533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144938558 | ||||||||
| FaxNumber: | 9144931488 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 WOODS RD | ||||||||
| Address2: | WESTCHESTER MEDICAL CENTER-PEDIATRICS | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105951530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144938558 | ||||||||
| FaxNumber: | 9144931488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 188474 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01369295 | 05 | NY | MEDICAID |