Provider Demographics
NPI:1780764365
Name:MUKENDI, MELCHIAS NJINGULULA (MD)
Entity type:Individual
Prefix:DR
First Name:MELCHIAS
Middle Name:NJINGULULA
Last Name:MUKENDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6115 97TH ST
Mailing Address - Street 2:APT 6F
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1247
Mailing Address - Country:US
Mailing Address - Phone:718-271-7489
Mailing Address - Fax:718-433-1019
Practice Address - Street 1:3511 QUEENS BLVD
Practice Address - Street 2:SUITES 01 & 02
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1720
Practice Address - Country:US
Practice Address - Phone:718-433-1015
Practice Address - Fax:718-433-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY187870208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744970Medicaid
NYF19926Medicare UPIN
NY02744970Medicaid