Healthcare Provider Details

I. General information

NPI: 1144462847
Provider Name (Legal Business Name): MATTHEW SAMUEL JOAQUIN MENDEZ-ZFASS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TEO MENDEZ M.D.

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E 74TH ST
NEW YORK NY
10021-3235
US

IV. Provider business mailing address

112 SAINT MARKS PL APT 1
BROOKLYN NY
11217-4843
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-3301
  • Fax:
Mailing address:
  • Phone: 804-347-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number275271
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number275271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: