Basic Information
| Provider Information | |||||||||
| NPI: | 1811214422 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCADO | ||||||||
| FirstName: | JONNA | ||||||||
| MiddleName: | ORTIZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236771 | ||||||||
| FaxNumber: | 2124238099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236771 | ||||||||
| FaxNumber: | 2124238099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 264384 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.