Provider Demographics
NPI:1003970948
Name:OZUNA MENDEZ, JANNY ALTAGRACIA (MD)
Entity type:Individual
Prefix:DR
First Name:JANNY
Middle Name:ALTAGRACIA
Last Name:OZUNA MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:917-853-8080
Mailing Address - Fax:
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:917-853-8080
Practice Address - Fax:718-956-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207078-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02760772Medicaid
NY207078-1OtherLICENSE
NY207078-1OtherLICENSE