Provider Demographics
NPI:1932175411
Name:MENDELSON, STUART G (MD)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:G
Last Name:MENDELSON
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 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006
Mailing Address - Country:US
Mailing Address - Phone:973-575-5065
Mailing Address - Fax:973-575-5270
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-575-5065
Practice Address - Fax:973-575-5270
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA543492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E55333Medicare UPIN
NJME602440Medicare ID - Type Unspecified