Provider Demographics
NPI:1588200992
Name:MENDELSOHN, BRUCE ROBERT
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ROBERT
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NIGHTVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-3643
Mailing Address - Country:US
Mailing Address - Phone:508-873-6324
Mailing Address - Fax:
Practice Address - Street 1:4 VALENTE DR
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2876
Practice Address - Country:US
Practice Address - Phone:508-870-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer