Provider Demographics
NPI:1215783584
Name:MOELLENDORF, MEGAN VICTORIA (MD SPECIAL EDUCATION)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:VICTORIA
Last Name:MOELLENDORF
Suffix:
Gender:F
Credentials:MD SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 92ND ST APT 2NF
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5814
Mailing Address - Country:US
Mailing Address - Phone:516-641-9018
Mailing Address - Fax:
Practice Address - Street 1:44 COURT ST STE 1217
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4410
Practice Address - Country:US
Practice Address - Phone:347-479-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist