Provider Demographics
NPI:1174565964
Name:MERCER INTERNISTS P.C.
Entity type:Organization
Organization Name:MERCER INTERNISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANASSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-393-0067
Mailing Address - Street 1:40 FULD ST
Mailing Address - Street 2:STE 302
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5247
Mailing Address - Country:US
Mailing Address - Phone:609-393-0067
Mailing Address - Fax:609-393-4943
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:STE 302
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-5247
Practice Address - Country:US
Practice Address - Phone:609-393-0067
Practice Address - Fax:609-393-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMA32182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6760708Medicaid
NJ6760708Medicaid
NJC31798Medicare UPIN