Provider Demographics
NPI:1871650853
Name:MENDOZA, MANUEL A JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:MENDOZA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4534
Mailing Address - Country:US
Mailing Address - Phone:516-565-3534
Mailing Address - Fax:516-565-2745
Practice Address - Street 1:717 FRONT ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4534
Practice Address - Country:US
Practice Address - Phone:516-565-3534
Practice Address - Fax:516-565-2745
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX007741OtherNYS MED LIC