Provider Demographics
NPI:1891087490
Name:JANNY A. OZUNA MENDEZ, MD, PLLC
Entity Type:Organization
Organization Name:JANNY A. OZUNA MENDEZ, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANNY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OZUNA MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-795-0100
Mailing Address - Street 1:1259 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1934
Mailing Address - Country:US
Mailing Address - Phone:212-795-0100
Mailing Address - Fax:212-795-0300
Practice Address - Street 1:1259 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1934
Practice Address - Country:US
Practice Address - Phone:212-795-0100
Practice Address - Fax:212-795-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-14
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02760772Medicaid
NY$$$$$$$$$OtherSOCIAL SECURITY