Provider Demographics
NPI:1124471156
Name:MENDEZ, MANUEL JACOBO JR (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:JACOBO
Last Name:MENDEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MILLBURN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1711
Mailing Address - Country:US
Mailing Address - Phone:973-376-8034
Mailing Address - Fax:
Practice Address - Street 1:235 MILLBURN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1711
Practice Address - Country:US
Practice Address - Phone:973-376-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11106300207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program