Healthcare Provider Details

I. General information

NPI: 1710476866
Provider Name (Legal Business Name): CARMELITA MENDOZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

IV. Provider business mailing address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6643
  • Fax: 484-526-4658
Mailing address:
  • Phone: 908-847-2621
  • Fax: 908-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00796400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: