Provider Demographics
NPI:1427156207
Name:MENDELOWITZ, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MENDELOWITZ
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 1:99 N BROADWAY
Mailing Address - Street 2:SLEEPY HOLLOW MEDICAL GROUP PC
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:914-631-0337
Mailing Address - Fax:914-631-0552
Practice Address - Street 1:99 N BROADWAY
Practice Address - Street 2:SLEEPY HOLLOW MEDICAL GROUP PC
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-631-0337
Practice Address - Fax:914-631-0552
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166232207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00996685Medicaid
NY084D04Medicare ID - Type Unspecified
NY00996685Medicaid