Healthcare Provider Details

I. General information

NPI: 1477612950
Provider Name (Legal Business Name): JOEL MENDELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 SPRINGFIELD AVE
MOUNTAINSIDE NJ
07092-2906
US

IV. Provider business mailing address

1124 SPRINGFIELD AVE
MOUNTAINSIDE NJ
07092-2906
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-4477
  • Fax:
Mailing address:
  • Phone: 908-233-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA04738300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number25MA04738300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: