Provider Demographics
NPI:1275672008
Name:MENDEGORIN, REMEDIOS VALENCIA (MD)
Entity Type:Individual
Prefix:
First Name:REMEDIOS
Middle Name:VALENCIA
Last Name:MENDEGORIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1134
Mailing Address - Country:US
Mailing Address - Phone:516-794-5739
Mailing Address - Fax:
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:W BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-761-3500
Practice Address - Fax:631-761-3630
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1572762084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry