Provider Demographics
NPI:1427389410
Name:MENDEZ, ALLAN ROQUE (PT, DPT, SCS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:ROQUE
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1018
Mailing Address - Country:US
Mailing Address - Phone:973-751-0230
Mailing Address - Fax:
Practice Address - Street 1:140 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1018
Practice Address - Country:US
Practice Address - Phone:973-751-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01338000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01338000OtherPHYSICAL THERAPY