Provider Demographics
NPI:1770712945
Name:MENGNJO, AUSTINE Y (MD)
Entity type:Individual
Prefix:DR
First Name:AUSTINE
Middle Name:Y
Last Name:MENGNJO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1030 REED AVENUE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2029
Mailing Address - Country:US
Mailing Address - Phone:610-376-7365
Mailing Address - Fax:610-376-1320
Practice Address - Street 1:1030 REED AVENUE
Practice Address - Street 2:SUITE 114
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2029
Practice Address - Country:US
Practice Address - Phone:610-376-7365
Practice Address - Fax:610-376-1320
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2017-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD443487207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026546140002Medicaid
PA230787GDFMedicare PIN