Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 25MA07829400 | NJ |
N | 2081P2900X | Pain Medicine | MD433452 | PA |
NPI | 1306927967 |
---|---|
Provider Name | Michael Joseph Mehnert |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Egg Harbor Township, NJ 08234-5549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2863679000 | IBC (01) | NJ |
5860856 | CIGNA (01) |