Provider Demographics
NPI:1669672101
Name:MUNDIA, ABDUL G (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:G
Last Name:MUNDIA
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 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-763-1962
Mailing Address - Fax:516-764-0060
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-763-1962
Practice Address - Fax:516-764-0060
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119258207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398614Medicaid
NY00398614Medicaid
NYB12597Medicare UPIN