Provider Demographics
NPI:1356463988
Name:MENDEZ, JORGE G (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:G
Last Name:MENDEZ
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 1:9 CRESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9007
Mailing Address - Country:US
Mailing Address - Phone:908-255-6200
Mailing Address - Fax:
Practice Address - Street 1:9 CRESTFIELD RD
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-9007
Practice Address - Country:US
Practice Address - Phone:908-255-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08542000207L00000X, 207LP2900X
CAA98830207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3394808Medicaid
CA00A988300OtherBLUE SHIELD
NJ0194786Medicaid
CA00A988300Medicaid
NJP00855796OtherRR MCR PTAN
CAWA98830AMedicare PIN
NJ0194786Medicare PIN
CA00A988300OtherBLUE SHIELD
NJ154819CDZMedicare PIN
NJ154819CDYMedicare PIN
CA00A988300Medicaid