Provider Demographics
NPI:1174951198
Name:JOHN V MENDOLA M D
Entity type:Organization
Organization Name:JOHN V MENDOLA M D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-709-3586
Mailing Address - Street 1:10 BETH STACEY BLVD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936
Mailing Address - Country:US
Mailing Address - Phone:201-709-3586
Mailing Address - Fax:
Practice Address - Street 1:10 BETH STACEY BLVD
Practice Address - Street 2:UNIT 104
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6047
Practice Address - Country:US
Practice Address - Phone:201-709-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 117536261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service