Healthcare Provider Details

I. General information

NPI: 1326137688
Provider Name (Legal Business Name): ANA MENDEZ MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 BUEL AVE
STATEN ISLAND NY
10305-1204
US

IV. Provider business mailing address

244 BUEL AVE
STATEN ISLAND NY
10305-1204
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-0642
  • Fax:
Mailing address:
  • Phone: 718-979-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANA V MENDEZ
Title or Position: DIRECTOR
Credential: MD
Phone: 718-979-0642