Provider Demographics
NPI:1043464738
Name:MENDRIBIL, MICHAEL (ND)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MENDRIBIL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E PUTNAM AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2734
Mailing Address - Country:US
Mailing Address - Phone:203-861-7810
Mailing Address - Fax:203-567-8444
Practice Address - Street 1:213 E PUTNAM AVE
Practice Address - Street 2:STE 5
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2734
Practice Address - Country:US
Practice Address - Phone:203-861-7810
Practice Address - Fax:203-567-8444
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000155175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath