Individual
DR. JACK MENSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9463
Mailing address
1 EDGEWATER ST, SUITE 723, STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
166900
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01158227
—
NM
Enumeration date
11/29/2005
Last updated
07/08/2007
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