Provider Demographics
NPI:1740420561
Name:GABOR MENCZELESZ MD PC
Entity Type:Organization
Organization Name:GABOR MENCZELESZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MENCZELESZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-368-1666
Mailing Address - Street 1:2563 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6201
Mailing Address - Country:US
Mailing Address - Phone:718-368-1666
Mailing Address - Fax:
Practice Address - Street 1:3049 OCEAN PKWY
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8372
Practice Address - Country:US
Practice Address - Phone:718-368-1666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01632466Medicaid
NYG08495Medicare UPIN
NY01632466Medicaid