Provider Demographics
NPI:1316335326
Name:FERMIN MERCEDES, DIOGENES (MD)
Entity type:Individual
Prefix:
First Name:DIOGENES
Middle Name:
Last Name:FERMIN MERCEDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W 168TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4134
Mailing Address - Country:US
Mailing Address - Phone:917-403-9220
Mailing Address - Fax:
Practice Address - Street 1:521 W 168TH ST APT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4134
Practice Address - Country:US
Practice Address - Phone:917-403-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-27
Last Update Date:2014-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14-208246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant