Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MA047383 | NJ |
N | 2080P0208X | Pediatric Infectious Diseases | MA047383 | NJ |
NPI | 1477612950 |
---|---|
Provider Name | Joel Mendelson |
First Address | Mountainside, NJ 07092-2906 |
Second Address | Mountainside, NJ 07092-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 27/03/2014 |