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General NPI Number Information
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NPI Number | 1568926822
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Entity Type | Organization
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Legal Business Name | FREDERIC A MENDELSOHN NEURODIAGNOSTICS INC
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 30 SEASIDE DR
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1132
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Country | US
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Telephone | 631-987-3705
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Fax |
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Provider Business Mailing Address
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Address Line | 30 SEASIDE DR
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1132
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Country | US
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Telephone | 631-987-3705
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. FREDERIC A MENDELSOHN
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Credential | MD
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Telephone | 631-987-3705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number |
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License Number State |
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