Provider Demographics
NPI:1457357667
Name:MENDOZA, RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:MENDOZA
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 1:48 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2037
Mailing Address - Country:US
Mailing Address - Phone:516-594-1173
Mailing Address - Fax:
Practice Address - Street 1:135 ROCKAWAY TPKE
Practice Address - Street 2:STE 103
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1023
Practice Address - Country:US
Practice Address - Phone:516-239-1616
Practice Address - Fax:516-239-2566
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171383207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02468MMedicare PIN
NY39F04Medicare PIN