Individual
KEN MERTUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-4000
Mailing address
6 SPENCER ST, HICKSVILLE, NY 11801-3363
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
79290901
NY
Other
Enumeration date
06/23/2025
Last updated
06/23/2025
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