Provider Demographics
NPI:1548428741
Name:JOSE M MENDEZ MD PC
Entity Type:Organization
Organization Name:JOSE M MENDEZ MD PC
Other - Org Name:UNIVERSAL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-779-3333
Mailing Address - Street 1:7902 ROOSEVELT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6717
Mailing Address - Country:US
Mailing Address - Phone:718-779-3333
Mailing Address - Fax:
Practice Address - Street 1:7902 ROOSEVELT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6717
Practice Address - Country:US
Practice Address - Phone:718-779-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty