Basic Information
| Provider Information | |||||||||
| NPI: | 1558369652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUND | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 HILLSIDE AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110402501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163543400 | ||||||||
| FaxNumber: | 5163540553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 MARCUS AVENUE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 128108 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.