Provider Demographics
NPI:1801851878
Name:MENDELSON, RANDY JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JAY
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AVENUE AT THE COMMONS #203
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-544-9072
Mailing Address - Fax:732-544-9079
Practice Address - Street 1:40 AVENUE AT THE COMMONS #203
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-544-9072
Practice Address - Fax:732-544-9072
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ2309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME660087Medicare ID - Type Unspecified
R32941Medicare UPIN