Provider Demographics
NPI:1043323835
Name:MENDELSON, MICHAEL W (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:MENDELSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5360 NESCONSET HGHY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2018
Mailing Address - Country:US
Mailing Address - Phone:631-331-3200
Mailing Address - Fax:631-331-3694
Practice Address - Street 1:5360 NESCONSET HGHY
Practice Address - Street 2:SUITE B
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2018
Practice Address - Country:US
Practice Address - Phone:631-331-3200
Practice Address - Fax:631-331-3694
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-05-24
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Provider Licenses
StateLicense IDTaxonomies
NY110115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78726Medicare UPIN
B78726Medicare UPIN
NY656521Medicare PIN