Provider Demographics
NPI:1396778130
Name:MENDER, DONALD MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MATTHEW
Last Name:MENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-0011
Mailing Address - Country:US
Mailing Address - Phone:845-485-7404
Mailing Address - Fax:845-887-6494
Practice Address - Street 1:201 SOUTH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4812
Practice Address - Country:US
Practice Address - Phone:845-485-7404
Practice Address - Fax:845-876-4946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1387302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00711179Medicaid
NY00711179Medicaid
A64479Medicare UPIN