Individual
DR. JORGE G MENDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9 CRESTFIELD RD, BOONTON, NJ 07005-9007
(908) 255-6200
Mailing address
9 CRESTFIELD RD, BOONTON, NJ 07005-9007
(908) 255-6200
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
25MA08542000
NJ
207L00000X
Anesthesiology Physician
A98830
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
25MA08542000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A988300
BLUE SHIELD
CA
05
—
00A988300
—
CA
05
—
0194786
—
NJ
05
—
3394808
—
NJ
01
—
P00855796
RR MCR PTAN
NJ
Enumeration date
04/04/2007
Last updated
11/26/2014
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