Provider Demographics
NPI:1902070840
Name:IGNACIO MERINO, ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:IGNACIO MERINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:IGNACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3511
Mailing Address - Country:US
Mailing Address - Phone:516-833-6952
Mailing Address - Fax:
Practice Address - Street 1:16625 POWELLS COVE BOULEVARD
Practice Address - Street 2:APARTMENT 1F
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1505
Practice Address - Country:US
Practice Address - Phone:718-767-5624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3833301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01272857Medicaid