Provider Demographics
NPI:1689043697
Name:KORMENDI, LINDA (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KORMENDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1208
Mailing Address - Country:US
Mailing Address - Phone:718-523-4141
Mailing Address - Fax:
Practice Address - Street 1:8339 DANIELS ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1208
Practice Address - Country:US
Practice Address - Phone:718-523-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-20
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018973-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant