Provider Demographics
NPI:1073994760
Name:MEDNIK, BELLA (DPM)
Entity Type:Individual
Prefix:DR
First Name:BELLA
Middle Name:
Last Name:MEDNIK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7704
Mailing Address - Country:US
Mailing Address - Phone:718-899-8700
Mailing Address - Fax:718-899-8701
Practice Address - Street 1:8710 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-899-8700
Practice Address - Fax:718-899-8701
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006976213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist