Provider Demographics
NPI:1518019207
Name:MENDEZ, JOSE A (PA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1710
Mailing Address - Country:US
Mailing Address - Phone:718-389-2500
Mailing Address - Fax:718-389-2781
Practice Address - Street 1:4710 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1710
Practice Address - Country:US
Practice Address - Phone:718-389-2500
Practice Address - Fax:718-389-2781
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005248208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics