Basic Information
| Provider Information | |||||||||
| NPI: | 1821399981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERRICK MEDICAL CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1703 MERRICK AVE | ||||||||
| Address2: | |||||||||
| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115661628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163783380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1703 MERRICK AVE | ||||||||
| Address2: | |||||||||
| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115661628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163783380 | ||||||||
| FaxNumber: | 5165461517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2010 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | NEELAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5163783380 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 172842 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.