Basic Information
| Provider Information | |||||||||
| NPI: | 1669853818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 MERRICK RD APT 3E | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115705450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054099349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 196 MERRICK RD | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115721420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162558414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2015 | ||||||||
| LastUpdateDate: | 06/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.