Healthcare Provider Details

I. General information

NPI: 1528658143
Provider Name (Legal Business Name): MARK NOWELL MENDOZA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5589
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5589
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5000
  • Fax: 347-906-9792
Mailing address:
  • Phone: 718-579-5000
  • Fax: 347-906-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: