Healthcare Provider Details

I. General information

NPI: 1902812258
Provider Name (Legal Business Name): DAVID C MEHL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 108TH ST
FOREST HILLS NY
11375-1355
US

IV. Provider business mailing address

334 EDWARD AVE
WOODMERE NY
11598-2823
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-1650
  • Fax:
Mailing address:
  • Phone: 516-569-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: