Provider Demographics
NPI:1033201306
Name:JAY S MENDELSOHN MD PA
Entity Type:Organization
Organization Name:JAY S MENDELSOHN MD PA
Other - Org Name:ASSOCIATES IN PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-963-5000
Mailing Address - Street 1:3230 STIRLING RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-963-5000
Mailing Address - Fax:954-963-5077
Practice Address - Street 1:3230 STIRLING RD
Practice Address - Street 2:SUITE #3
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-963-5000
Practice Address - Fax:954-963-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040148208100000X
FLME0063435208100000X
FLME0073257208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253674900Medicaid
FL77056Medicare PIN