Basic Information
| Provider Information | |||||||||
| NPI: | 1497112056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERSON | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 COLONEL ROBERT MAGAW PL # 25 | ||||||||
| Address2: | APT #6C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100335252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466929862 | ||||||||
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| Practice Location | |||||||||
| Address1: | 116 W 32ND ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100013212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665519700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2016 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 681319 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.