Healthcare Provider Details

I. General information

NPI: 1689833261
Provider Name (Legal Business Name): MARY KIM MEHLMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE SUITE 100
HEMPSTEAD NY
11550-3718
US

IV. Provider business mailing address

222 STATION PLZ N SUITE 611
MINEOLA NY
11501-3800
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-1034
  • Fax: 516-292-0565
Mailing address:
  • Phone: 516-663-2532
  • Fax: 516-663-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: