Provider Demographics
NPI:1275659518
Name:MENDOZA, MERCEDES (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 2ND AVE
Mailing Address - Street 2:APT#2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4104
Mailing Address - Country:US
Mailing Address - Phone:212-996-7554
Mailing Address - Fax:
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:212-982-5226
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000538-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant