Provider Demographics
NPI:1003905662
Name:MENDELSOHN, EDWARD JOEL (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOEL
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 UNION SQ W
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3217
Mailing Address - Country:US
Mailing Address - Phone:212-750-1110
Mailing Address - Fax:212-750-1140
Practice Address - Street 1:37 UNION SQ W
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3217
Practice Address - Country:US
Practice Address - Phone:212-750-1110
Practice Address - Fax:212-750-1140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202108208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG26499Medicare UPIN
NYA400052157Medicare PIN