Provider Demographics
NPI:1669760641
Name:EDWARD MENDELSOHN, MD PLLC
Entity type:Organization
Organization Name:EDWARD MENDELSOHN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-750-1110
Mailing Address - Street 1:853 BROADWAY
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-750-1110
Mailing Address - Fax:212-750-1140
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-750-1110
Practice Address - Fax:212-750-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
NY202108208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100052155Medicare PIN