Provider Demographics
NPI:1093754210
Name:MENDOLA, ANTONY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:JOSEPH
Last Name:MENDOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1217
Mailing Address - Country:US
Mailing Address - Phone:914-949-1199
Mailing Address - Fax:914-941-1245
Practice Address - Street 1:PARK AVENUE HEALTH CARE
Practice Address - Street 2:3 BARKER AVE, 4TH FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-949-1199
Practice Address - Fax:914-949-1245
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194664-12084P0800X
FLME 952142084P0800X
NJ25MA066864002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01653910Medicaid
NY01653910Medicaid
NY900081Medicare ID - Type Unspecified