1023325438 NPI number — MENDELSON ORTHOPEDICS PC

Table of content: (NPI 1023325438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023325438 NPI number — MENDELSON ORTHOPEDICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENDELSON ORTHOPEDICS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MENDELSON KORNBLUM ORTHOPEDIC PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023325438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 STEPHENSON HWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-439-6258
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13488 E 11 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48089-1366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-439-6243
Provider Business Practice Location Address Fax Number:
586-439-6240
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MENDELSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
586-261-1960

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  L1181507 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: L756863 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: L1137382 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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