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NPI Code Detail

MEDICARE: ISMAEL M MENDOZA P.T.

MEDICARE:   ISMAEL M MENDOZA  P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist022476NY

General Provider Information

NPI Number : 1417925454
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISMAEL M MENDOZA P.T.
Provider Business Mailing Address
First Line : 8 PILGRIM LN
Second Line :
City : WESTBURY
State : NY
Zip : 11590-6217
Country : US
Telephone Number : 516-338-1021
Fax Number :
Provider Business Practice Location Address
First Line : 3711 QUEENS BLVD
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-1725
Country : US
Telephone Number : 718-361-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 12/10/2012

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Directions to “ ISMAEL M MENDOZA P.T.” Practice Location

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