Provider Demographics
NPI:1194786277
Name:MEROLA, JOSEPH ALPHONSE (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALPHONSE
Last Name:MEROLA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1707
Mailing Address - Country:US
Mailing Address - Phone:315-687-6467
Mailing Address - Fax:315-251-2240
Practice Address - Street 1:3709 ERIE BLVD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:NY
Practice Address - Zip Code:13214-2227
Practice Address - Country:US
Practice Address - Phone:315-251-2244
Practice Address - Fax:315-251-2240
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007463363AM0700X
NY007463-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02508501Medicaid
NY02508501Medicaid
NYP37446Medicare UPIN
NYCC7509Medicare PIN
NYJ400037471Medicare PIN