Provider Demographics
NPI:1811955461
Name:FREDERICK S MENDELSOHN MD PC
Entity type:Organization
Organization Name:FREDERICK S MENDELSOHN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-988-5841
Mailing Address - Street 1:950 PARK AVE
Mailing Address - Street 2:FREDERICK S MENDELSOHN MD PC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0320
Mailing Address - Country:US
Mailing Address - Phone:212-988-5841
Mailing Address - Fax:212-580-7067
Practice Address - Street 1:950 PARK AVE
Practice Address - Street 2:FREDERICK S MENDELSOHN MD PC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0320
Practice Address - Country:US
Practice Address - Phone:212-988-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0839232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00125764Medicaid
264691Medicare ID - Type Unspecified
NY00125764Medicaid