Provider Demographics
NPI:1972679835
Name:MENDOZA, NARCISO DIZON (MD)
Entity Type:Individual
Prefix:MR
First Name:NARCISO
Middle Name:DIZON
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MULE ROAD
Mailing Address - Street 2:SUITE E5
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-240-3710
Mailing Address - Fax:732-240-3783
Practice Address - Street 1:9 MULE ROAD
Practice Address - Street 2:SUITE E5
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-240-3710
Practice Address - Fax:732-240-3783
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03628600207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDO60502OtherCOS
NJ0867403Medicaid
NJMA36286OtherLICENSE #
NJMA36286OtherLICENSE #
NJMA36286OtherLICENSE #
NJ0867403Medicaid