Provider Demographics
NPI:1699462366
Name:MERCEDES, CRISTAL
Entity type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:MERCEDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 AUDUBON AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4626
Mailing Address - Country:US
Mailing Address - Phone:917-756-5538
Mailing Address - Fax:
Practice Address - Street 1:471 AUDUBON AVE APT 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4626
Practice Address - Country:US
Practice Address - Phone:917-756-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator