Provider Demographics
NPI:1245235126
Name:MENDU, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:MENDU
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 1:10 JEFFERSON PLZ
Mailing Address - Street 2:STE. 100
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9542
Mailing Address - Country:US
Mailing Address - Phone:732-274-1274
Mailing Address - Fax:732-355-0321
Practice Address - Street 1:10 JEFFERSON PLZ
Practice Address - Street 2:STE. 100
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9542
Practice Address - Country:US
Practice Address - Phone:732-274-1274
Practice Address - Fax:732-355-0321
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06750500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7774605Medicaid
NJG85891Medicare UPIN