Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 202108 | NY |
NPI | 1003905662 |
---|---|
Provider Name | Edward Joel Mendelsohn |
First Address | New York, NY 10003-3217 |
Second Address | New York, NY 10003-3217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 10/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G26499 | (02) | NY |