Healthcare Provider Details

I. General information

NPI: 1588478218
Provider Name (Legal Business Name): EDDIE E MENDEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 PARK AVE
EDISON NJ
08820-2508
US

IV. Provider business mailing address

3848 PARK AVE
EDISON NJ
08820-2508
US

V. Phone/Fax

Practice location:
  • Phone: 732-201-5232
  • Fax:
Mailing address:
  • Phone: 732-201-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: