Provider Demographics
NPI:1811988033
Name:MENTAKIS, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MENTAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:260 COCHITUATE RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-628-9660
Mailing Address - Fax:508-628-9668
Practice Address - Street 1:357 W SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:U SADDLE RIV
Practice Address - State:NJ
Practice Address - Zip Code:07458-1617
Practice Address - Country:US
Practice Address - Phone:201-327-2248
Practice Address - Fax:201-327-3510
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA218305207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ178036Medicare PIN
D19579Medicare UPIN