Provider Demographics
NPI:1861708216
Name:CARL F MERCURIO MD PA
Entity type:Organization
Organization Name:CARL F MERCURIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GINGERELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-751-3222
Mailing Address - Street 1:36 NEWARK AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4119
Mailing Address - Country:US
Mailing Address - Phone:973-751-3222
Mailing Address - Fax:973-751-1040
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4119
Practice Address - Country:US
Practice Address - Phone:973-751-3222
Practice Address - Fax:973-751-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34184207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53858Medicare UPIN