Healthcare Provider Details

I. General information

NPI: 1851733497
Provider Name (Legal Business Name): MR. JEFFREY DAVID MENDELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LINCOLN RD N
PLAINVIEW NY
11803-5324
US

IV. Provider business mailing address

24 LINCOLN RD N
PLAINVIEW NY
11803-5324
US

V. Phone/Fax

Practice location:
  • Phone: 516-236-8234
  • Fax:
Mailing address:
  • Phone: 516-236-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1324383
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: