# JORGE G. MENDEZ,MD. LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ivy League Pain Management Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669870689
- **Authorized official:** DR. JORGE G. MENDEZ MD (PRESIDENT)
- **Authorized official phone:** (908) 255-6200

## Contact information

- **Practice address:** 9 CRESTFIELD RD, BOONTON, NJ 07005-9007
- **Practice address phone:** (908) 255-6200
- **Practice address fax:** (973) 794-4261
- **Mailing address:** 9 CRESTFIELD RD, BOONTON, NJ 07005-9007
- **Mailing address phone:** (908) 255-6200
- **Mailing address fax:** (973) 794-4261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 25MA08542000 | NJ | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 25MA08542000 | NJ | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 12/08/2014
- **Last updated:** 03/13/2019