Provider Demographics
NPI:1053415547
Name:MENDES, DONNA MARIA (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIA
Last Name:MENDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W 66TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6206
Mailing Address - Country:US
Mailing Address - Phone:212-302-3051
Mailing Address - Fax:212-496-2948
Practice Address - Street 1:10 W 66TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6206
Practice Address - Country:US
Practice Address - Phone:212-302-3051
Practice Address - Fax:212-496-2948
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008369573Medicaid
C04794Medicare UPIN
NYO4D261Medicare ID - Type Unspecified