Provider Demographics
NPI:1710974654
Name:MENDIOLA, REDENTOR S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:REDENTOR
Middle Name:S
Last Name:MENDIOLA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:908-277-8825
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:SUMMIT MEDICAL GROUP
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-273-4300
Practice Address - Fax:908-277-8825
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-07-09
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07632500207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072118BSDMedicare ID - Type UnspecifiedMEDICARE#
NJH91494Medicare UPIN