Basic Information
| Provider Information | |||||||||
| NPI: | 1497741532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDELSON | ||||||||
| FirstName: | ALI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514200 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 S BRYN MAWR AVE | ||||||||
| Address2: | |||||||||
| City: | BRYN MAWR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190103121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843373000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 233946 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | MD468483 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 3C5202 | 01 | HEALTHNET GRP ID# | OTHER | 02727509 | 05 | NY | MEDICAID | 0604050000013 | 01 | FIDELISCARE PROVIDER ID# | OTHER | 10101978-U104 | 01 | CDPHP PROVIDER & GRP ID# | OTHER | P3627881 | 01 | OXFORD HEALTH PLAN PIN# | OTHER | 000000092370 | 01 | GHI HMO PROVIDER ID# | OTHER | 1093491 | 01 | AETNA-HMO PROVIDER ID# | OTHER | 388179 | 01 | MVP HEALTHPLAN PIN# | OTHER | 634Z61 | 01 | EMPIRE BCBS PROVIDER ID# | OTHER | 7187742 | 01 | AETNA-PPO PROVIDER ID# | OTHER |