Provider Demographics
NPI:1285738229
Name:MERCOGLIANO, EDWARD ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:MERCOGLIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWARD
Other - Middle Name:ANTHONY
Other - Last Name:MERK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:181 FRANKLIN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3820
Mailing Address - Country:US
Mailing Address - Phone:973-284-0370
Mailing Address - Fax:973-667-8547
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3820
Practice Address - Country:US
Practice Address - Phone:973-284-0370
Practice Address - Fax:973-667-8547
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02603700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2839300Medicaid
NJ0000026294OtherLOCAL 825
NJ208060800OtherUS DEPT OF LABOR
NJ208060800OtherUS DEPT OF LABOR
NJC56109Medicare UPIN