Provider Demographics
NPI:1992877419
Name:MERSON, AMALIA (MD)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:MERSON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:760 BROADWAY WOODHULL MEDICAL & MENTAL HEALTH CENTER
Mailing Address - Street 2:DEPARTMENT OF MANAGED CARE, 2B-230
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-630-3020
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:760 BROADWAY WOODHULL MEDICAL & MENTAL HEALTH CENTER
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-283-8796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2043042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01841529Medicaid
NYG46690Medicare UPIN
NY51M891Medicare ID - Type Unspecified