Provider Demographics
NPI:1083261523
Name:MENDEZ, JOHANN (SPECIAL ED TEACHER)
Entity Type:Individual
Prefix:
First Name:JOHANN
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9452 MAGNOLIA CT # 1B
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2958
Mailing Address - Country:US
Mailing Address - Phone:917-680-8252
Mailing Address - Fax:
Practice Address - Street 1:9452 MAGNOLIA CT # 1B
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2958
Practice Address - Country:US
Practice Address - Phone:917-680-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty