Provider Demographics
NPI:1922054022
Name:MENTLE, IRIS ROBIN (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:ROBIN
Last Name:MENTLE
Suffix:
Gender:F
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-866-0800
Mailing Address - Fax:732-463-6082
Practice Address - Street 1:901 W MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-866-0800
Practice Address - Fax:732-463-6082
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06445500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7556403Medicaid
NJ047213OtherMEDICARE
NJG60558Medicare UPIN
NJ7556403Medicaid