Individual
MRS. CARROLL ANN MENDONCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
12711 111TH AVE, SOUTH OZONE PARK, NY 11420-1604
(718) 322-7967
(718) 738-2236
Mailing address
12711 111TH AVE, SOUTH OZONE PARK, NY 11420-1604
(718) 738-2236
(718) 738-2195
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
022988
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02285481
—
NY
01
—
022988-A81
HEALTHFIRST
NY
01
—
126019P
HIP
NY
01
—
69520
CAREPLUS
NY
01
—
98123701
NEIGHBORHOOD HEALTH PROVI
NY
01
—
GQ537
BLUE CROSS BLUE SHIELD
NY
01
—
XC2685
HEALTHNET
NY
Enumeration date
08/31/2006
Last updated
07/08/2007
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