Provider Demographics
NPI:1982043972
Name:MENDELSON, ELIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIE
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 KIMBERLY BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2862
Mailing Address - Country:US
Mailing Address - Phone:561-483-4448
Mailing Address - Fax:561-483-2167
Practice Address - Street 1:9080 KIMBERLY BLVD STE 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2862
Practice Address - Country:US
Practice Address - Phone:561-483-4448
Practice Address - Fax:561-483-2167
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR338213ES0103X
FLPO3704213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery