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General NPI Number Information
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NPI Number | 1619390861
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Entity Type | Organization
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Legal Business Name | MENDORES PC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 62 CAMERON RD
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City | BERGENFIELD
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State | NJ
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Zip | 07621-3303
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Country | US
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Telephone | 201-244-6932
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Fax |
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Provider Business Mailing Address
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Address Line | 62 CAMERON RD
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City | BERGENFIELD
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State | NJ
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Zip | 07621-3303
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Country | US
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Telephone | 201-244-6932
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC MENDOZA FLORES
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Credential | PT
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Telephone | 201-982-0666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01159700
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License Number State | NJ
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