Provider Demographics
NPI:1427143478
Name:MENDEL, HAL R (OD)
Entity type:Individual
Prefix:DR
First Name:HAL
Middle Name:R
Last Name:MENDEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19A RYE RIDGE PLZ
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2822
Mailing Address - Country:US
Mailing Address - Phone:914-939-2224
Mailing Address - Fax:914-939-4382
Practice Address - Street 1:19A RYE RIDGE PLZ
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2822
Practice Address - Country:US
Practice Address - Phone:914-939-2224
Practice Address - Fax:914-939-4382
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY3275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00331457Medicaid
NYNY3275OtherLICENSE NUMBER
NY00331457Medicaid
NYC26801Medicare ID - Type UnspecifiedPROVIDER NUMBER
NY132922377OtherTAX ID NUMBER
NYNY3275OtherLICENSE NUMBER