Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 210461 | NY |
N | 111NI0900X | Internist | 210461 | NY |
N | 207R00000X | Internist | ME122201 | FL |
N | 111NI0900X | Internist | ME122201 | FL |
Y | 207RA0401X | Internist - Addiction Medicine | ME122201 | FL |
NPI | 1609869833 |
---|---|
Provider Name | Dr. Gabor Menczelesz |
First Address | Elkton, FL 32033-4015 |
Second Address | Saint Augustine, FL 32086-6467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G08495 | (02) |