MEDICARE: DR. GABOR MENCZELESZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME122201	FL
2	207R00000X	Internal Medicine Physician	ME122201	FL
3	207R00000X	Internal Medicine Physician	210461	NY
4	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME122201	FL

General Provider Information

NPI Number	:	1609869833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABOR MENCZELESZ MD

Provider Business Mailing Address
First Line	:	4620 PEELE ST
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-4015
Country	:	US
Telephone Number	:	904-302-1558
Fax Number	:	904-562-3343

Provider Business Practice Location Address
First Line	:	3574 US HIGHWAY 1 S STE 102
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6467
Country	:	US
Telephone Number	:	904-217-7161
Fax Number	:	904-217-4075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/21/2024

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