Healthcare Provider Details

I. General information

NPI: 1366774226
Provider Name (Legal Business Name): MENDELSON MD PC & ROSENTHAL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 NESCONSET HWY
PT. JEFF. STA NY
11776
US

IV. Provider business mailing address

5360 NESCONSET HWY
PT JEFF STA NY
11776-2018
US

V. Phone/Fax

Practice location:
  • Phone: 631-331-2121
  • Fax: 631-331-3694
Mailing address:
  • Phone: 631-331-2121
  • Fax: 631-331-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH G. ROSENTHAL
Title or Position: PARTNER
Credential: M.D.
Phone: 631-331-2121