Provider Demographics
NPI:1194736215
Name:MENCHE, DAVID S (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:MENCHE
Suffix:
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 1:521 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8140
Mailing Address - Country:US
Mailing Address - Phone:718-369-8043
Mailing Address - Fax:718-679-9598
Practice Address - Street 1:521 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8140
Practice Address - Country:US
Practice Address - Phone:718-369-8043
Practice Address - Fax:718-679-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12253Medicare UPIN
NYA300027502Medicare PIN
NY85A641Medicare PIN
NY61G95Q4AC1Medicare PIN