Provider Demographics
NPI:1457497109
Name:MENDOZA, ELEANOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:MENDOZA
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 1:800 SPENCERPORT RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4820
Mailing Address - Country:US
Mailing Address - Phone:585-426-4880
Mailing Address - Fax:585-426-8104
Practice Address - Street 1:800 SPENCERPORT RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4820
Practice Address - Country:US
Practice Address - Phone:585-426-4880
Practice Address - Fax:585-426-8104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10427BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYE87419Medicare UPIN