Provider Demographics
NPI:1609869833
Name:MENCZELESZ, GABOR (MD)
Entity Type:Individual
Prefix:DR
First Name:GABOR
Middle Name:
Last Name:MENCZELESZ
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 1:4620 PEELE ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:FL
Mailing Address - Zip Code:32033-4015
Mailing Address - Country:US
Mailing Address - Phone:904-302-1558
Mailing Address - Fax:904-562-3343
Practice Address - Street 1:3574 US HIGHWAY 1 S STE 102
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6467
Practice Address - Country:US
Practice Address - Phone:904-217-7161
Practice Address - Fax:904-217-4075
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122201207Q00000X, 207R00000X, 207RA0401X
NY210461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G08495Medicare UPIN
NY016322466Medicaid
NY44J201Medicare PIN