Provider Demographics
NPI:1386616076
Name:MEND PA
Entity type:Organization
Organization Name:MEND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BUCHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-549-7470
Mailing Address - Street 1:2 LINCOLN HWY
Mailing Address - Street 2:501
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:732-549-7470
Mailing Address - Fax:732-494-8596
Practice Address - Street 1:2 LINCOLN HWY
Practice Address - Street 2:501
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-549-7470
Practice Address - Fax:732-494-8596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJME445889OtherMEDICARE GROUP #
NJ279900620Medicaid
NJCF1917OtherRAILROAD MEDICARE