Basic Information
| Provider Information | |||||||||
| NPI: | 1508026477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEIL H MERKATZ, M.D. PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2563 | ||||||||
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| City: | GLENVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123250563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183841517 | ||||||||
| FaxNumber: | 5183841358 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 SE HILLMOOR DR | ||||||||
| Address2: | SUITE 17 | ||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349527552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723359808 | ||||||||
| FaxNumber: | 7723359818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 03/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | QUICK | ||||||||
| AuthorizedOfficialFirstName: | MARY-JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7723841517 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | ME 68994 | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | ME 68994 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 378915200 | 05 | FL | MEDICAID |