Provider Demographics
NPI:1609858455
Name:MENCEL, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MENCEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1147
Mailing Address - Country:US
Mailing Address - Phone:732-528-0760
Mailing Address - Fax:732-528-0764
Practice Address - Street 1:1707 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1147
Practice Address - Country:US
Practice Address - Phone:732-528-0760
Practice Address - Fax:732-528-0764
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05491800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5643406Medicaid
NJ5643406Medicaid
NJ467811Q4JMedicare ID - Type Unspecified