Healthcare Provider Details

I. General information

NPI: 1225239213
Provider Name (Legal Business Name): DEBORAH J MENSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 76TH AVE SUITE CH 139
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

26901 76TH AVE SUITE CH 139
NEW HYDE PARK NY
11040-1433
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7350
  • Fax: 718-347-5864
Mailing address:
  • Phone: 718-470-7350
  • Fax: 718-347-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number231992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: