Provider Demographics
NPI:1023348596
Name:MENDOZA, LYNETTE MARIA (MS, DO)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:MARIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:718 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4245
Mailing Address - Country:US
Mailing Address - Phone:201-833-3357
Mailing Address - Fax:201-541-5972
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-833-3357
Practice Address - Fax:201-541-5972
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10190500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty