Provider Demographics
NPI:1922646132
Name:PIERRE MENDOZA MD LLC
Entity Type:Organization
Organization Name:PIERRE MENDOZA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-304-1718
Mailing Address - Street 1:1 POCANO AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1717
Mailing Address - Country:US
Mailing Address - Phone:732-664-0282
Mailing Address - Fax:
Practice Address - Street 1:9 MULE RD STE 5
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5052
Practice Address - Country:US
Practice Address - Phone:732-240-3710
Practice Address - Fax:732-240-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty