Provider Demographics
NPI:1689893133
Name:OUR LADY OF MERCY MEDICAL CENTER
Entity type:Organization
Organization Name:OUR LADY OF MERCY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALK-DOMITROVITS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-ANP
Authorized Official - Phone:347-341-4373
Mailing Address - Street 1:2 WEST LAWRENCE PK DR
Mailing Address - Street 2:UNIT 6
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968
Mailing Address - Country:US
Mailing Address - Phone:914-572-3491
Mailing Address - Fax:
Practice Address - Street 1:600 EAST 233RD ST.
Practice Address - Street 2:DIABETES CLINIC MERCY COMMUNITY CARE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:347-341-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301189282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMH0844969OtherDEA#
NYMH0844969OtherDEA#
901V451Medicare ID - Type Unspecified