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General NPI Number Information
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NPI Number | 1992142558
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Entity Type | Individual
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Provider Name | JERALD AGUILA MENDOZA PT
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Gender | Male
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 717 FRONT ST
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City | HEMPSTEAD
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State | NY
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Zip | 11550-4534
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Country | US
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Telephone | 516-565-4370
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Fax | 516-565-2644
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Provider Business Mailing Address
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Address Line | 3 DOSORIS LN
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City | GLEN COVE
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State | NY
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Zip | 11542-1539
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Country | US
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Telephone | 516-609-9400
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 030296
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License Number State | NY
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