Provider Demographics
NPI:1295783041
Name:MENGE, HELEN DONNA (CNM, NP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:DONNA
Last Name:MENGE
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117-3504
Mailing Address - Country:US
Mailing Address - Phone:518-661-5273
Mailing Address - Fax:518-220-9263
Practice Address - Street 1:951 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1409
Practice Address - Country:US
Practice Address - Phone:518-220-2022
Practice Address - Fax:518-220-9263
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420702-1363LW0102X
NYF360460-1363LX0001X
NYF001132-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2600513OtherUNITED HEALTHCARE
NY02730569Medicaid
NY793072OtherMVP HEALTHCARE