Healthcare Provider Details

I. General information

NPI: 1588820526
Provider Name (Legal Business Name): MENDELSOHN ENDOCRINOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 E 73RD ST
NEW YORK NY
10021-4208
US

IV. Provider business mailing address

3515 HENRY HUDSON PKWY #10E
BRONX NY
10463-1326
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-3007
  • Fax: 212-327-3008
Mailing address:
  • Phone: 917-502-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number60238947
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number046809
License Number StateCT

VIII. Authorized Official

Name: DR. FELICIA ANN MENDELSOHN
Title or Position: OWNER/SOLE PROPRIETOR
Credential: M.D.
Phone: 917-502-6822