Provider Demographics
NPI:1629201041
Name:MENDEN, MICHELLE Y (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Y
Last Name:MENDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:YVONNE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:310 WOODSTOWN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2080
Practice Address - Country:US
Practice Address - Phone:856-935-1000
Practice Address - Fax:856-935-4757
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00317500367500000X
DEL6-0A00585367500000X
DEL1-0030091163W00000X
NJ26NR10315300163W00000X
PARN582566367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
82592OtherAANA
NJP01201184OtherRAILROAD MEDICARE
82592OtherAANA
NJ216382Medicare PIN