Provider Demographics
NPI:1992914147
Name:MENDEZ MORALES, ALBA NYDIA (MD)
Entity type:Individual
Prefix:DR
First Name:ALBA
Middle Name:NYDIA
Last Name:MENDEZ MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:65 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEAPACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07977
Mailing Address - Country:US
Mailing Address - Phone:908-234-0011
Mailing Address - Fax:908-719-2137
Practice Address - Street 1:65 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PEAPACK
Practice Address - State:NJ
Practice Address - Zip Code:07977
Practice Address - Country:US
Practice Address - Phone:908-234-0011
Practice Address - Fax:908-719-2137
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08761000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics