Provider Demographics
NPI:1629082060
Name:DAVID C. MEHL DPM PC
Entity Type:Organization
Organization Name:DAVID C. MEHL DPM PC
Other - Org Name:FOREST HILLS FAMILY FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-896-1650
Mailing Address - Street 1:6310 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1355
Mailing Address - Country:US
Mailing Address - Phone:718-896-1650
Mailing Address - Fax:718-896-3088
Practice Address - Street 1:6310 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1355
Practice Address - Country:US
Practice Address - Phone:718-896-1650
Practice Address - Fax:718-896-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004175213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256459Medicaid
NY81883Medicare ID - Type Unspecified
NYT32120Medicare UPIN
NY01256459Medicaid