Healthcare Provider Details

I. General information

NPI: 1427002435
Provider Name (Legal Business Name): JENNIFER H MENELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 SOUTH BEDFORD ROAD CARE MOUNT MEDICAL, PC
MT. KISCO NY
10549-3412
US

IV. Provider business mailing address

110 SOUTH BEDFORD ROAD CARE MOUNT MEDICAL , PC
MT. KISCO NY
10549-3412
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number203526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: