Healthcare Provider Details

I. General information

NPI: 1285357301
Provider Name (Legal Business Name): HILLARY MENDIETA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E STE 3A
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

7005 66TH PL
GLENDALE NY
11385-6509
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: