Provider Demographics
NPI:1982619854
Name:MUNDY, TODD ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ALEXANDER
Last Name:MUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5450
Mailing Address - Country:US
Mailing Address - Phone:718-622-2608
Mailing Address - Fax:718-622-5104
Practice Address - Street 1:506 SIXTH STREET
Practice Address - Street 2:THE METHODIST HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-780-3159
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229076207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02528114Medicaid
CA00A936200Medicaid
NY02528114Medicaid
NY0461Q1Medicare PIN
CA00A936200Medicare PIN