Provider Demographics
NPI:1285787184
Name:MENDEL, STUART HERBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:HERBERT
Last Name:MENDEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 3RD AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2730
Mailing Address - Country:US
Mailing Address - Phone:212-230-1057
Mailing Address - Fax:
Practice Address - Street 1:940 3RD AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2710
Practice Address - Country:US
Practice Address - Phone:212-230-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02965122300000X
NY0367171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist