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General NPI Number Information
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NPI Number | 1780440313
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Entity Type | Individual
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Provider Name | GLADYS MARIA MENDOZA FNP
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Gender | Female
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 09/01/2024
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Provider Practice Location Address
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Address Line | 377 JERSEY AVE STE 310
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City | JERSEY CITY
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State | NJ
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Zip | 07302-4397
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Country | US
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Telephone | 201-706-2091
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Fax | 201-706-2092
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Provider Business Mailing Address
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Address Line | 12 PRINCETON TER
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City | BELLEVILLE
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State | NJ
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Zip | 07109-2102
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Country | US
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Telephone | 201-468-7093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15010400
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License Number State | NJ
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