Provider Demographics
NPI:1033512843
Name:MOUNT VERNON MEDICAL PRACTICE
Entity Type:Organization
Organization Name:MOUNT VERNON MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:646-207-9934
Mailing Address - Street 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE 1-4
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-633-5700
Mailing Address - Fax:914-633-0446
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE 1-4
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-633-5700
Practice Address - Fax:914-633-0446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTOPHER ADUBOR PHYSICIAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338574-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care