GLENN J MENDOZA (NPI# 1205823796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205823796 |
| Entity Type | Individual |
| Full Name | GLENN J MENDOZA |
| Credential | MD |
| Practice Address |
255 Lafayette Ave Suffern NY 10901-4817 |
| Mailing Address |
95 Grasslands Rd Munger Pavilion Ste 120 Valhalla NY 10595-1652 |
| Practice Telephone | 9144938558 |
| Practice Fax Number | 9144931488 |
| Mailing Telephone | 9144938558 |
| Mailing Fax Number | 9144931488 |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2008-09-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
148338 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 7414706 | 05 | |
| NY | 00992998 | 05 |
| Street Address |
255 LAFAYETTE AVE |
| City | SUFFERN |
| State | NY |
| Zip Code | 10901-4817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184616963 | Martin S Katzenstein | Pediatrics | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2005-08-18 |
| 1184232894 | Jennifer Peterson | Nurse Practitioner | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2020-07-20 |
| 1396360186 | Tina George | Nurse Practitioner | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2020-06-08 |
| 1053943902 | Michelle Lindsay Mathew | Nurse Practitioner | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2020-02-09 |
| 1174155162 | Rockland Physician Medicine Services, P.C. | Physician Assistant | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2020-02-07 |
| 1659847416 | Teresa Ann Sullivan | Nurse Practitioner | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2018-10-19 |
| 1134694334 | Damar Titsy-ann Mcintyre | Nurse Practitioner | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2018-10-04 |
| 1962988543 | Rena Marie Riccardi | Nutritionist | 255 Lafayette Ave, Suffern, NY 10901-4869 | 2018-07-17 |
| 1730638453 | Patricia Margaret Kivlehan | Nurse Practitioner | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2016-09-22 |
| 1609251370 | Melissa Theodore | Physical Therapist | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2015-07-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740895309 | Constance Marie Princiotto | Registered Nurse | J&d Ultracare, 15 Suffern Pl, Suffern, NY 10901 | 2020-09-10 |
| 1376101790 | Tenika Filomena Walters | Licensed Practical Nurse | 15 Suffen Place, Suffen, NY 10901 | 2019-05-31 |
| 1922563261 | Matthew Abel | Dietitian, Registered | 156 Ny-59, A2, Suffern, NY 10901 | 2019-01-31 |
| 1609349422 | Yona Newmark | Behavioral Analyst | 84 Route 59 Suite 102, Suffern, NY 10901 | 2019-01-03 |
| 1235606005 | William M Mazariego | Specialist/Technologist | 5 Tallman Pl, Suffern, NY 10901 | 2018-10-30 |
| 1396237228 | Stephanie N Freer | Registered Nurse | 15 Suffern Pl., Suffern, NY 10901 | 2018-06-06 |
| 1588102669 | Lisa Arcuri | Registered Nurse | 15 Suffern Place Ste A, Suffern, NY 10901 | 2017-02-08 |
| 1801342787 | Maria Castro-cancel | Social Worker | 58 Campbell Avenue, Airmont, NY 10901 | 2016-08-30 |
| 1811341530 | Simone Raven Pringle | Licensed Practical Nurse | 15 Suffern Place, Suite A, Suffern, NY 10901 | 2016-04-19 |
| 1871998666 | Simi Samuel | Specialist | 13 Hillside Ct, Suffern, NY 10901 | 2014-10-23 |
| Find all providers in zip 10901 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184616963 | Martin S Katzenstein | Pediatrics | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2005-08-18 |
| 1730185059 | Rita Fischer | Pediatrics | 100 Route 59, Ste 103a, Suffern, NY 10901-4927 | 2005-06-22 |
| 1528001419 | Michael Onofrio Petrella | Pediatrics | 255 Lafayette Ave, Suffern, NY 10901-4812 | 2006-06-14 |
| 1750388351 | Elizabeth Hailu | Pediatrics | 100 Route 59, Ste 103a, Suffern, NY 10901-4927 | 2005-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447893193 | Karen Lynn Marsh | Pediatrics | 64 Willow St, Guilderland, NY 12084-9778 | 2019-10-25 |
| 1497227094 | Alison Kent | Pediatrics | Dept of Pediatrics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642 | 2018-12-20 |
| 1639697329 | Lily Michelle Barres | Pediatrics | 601 Elmwood Ave Box 651, Rochester, NY 14642-0001 | 2017-09-01 |
| 1093238339 | Maria Pygerou-kofinas | Pediatrics | 506 Sixth Street Kp4, Brooklyn, NY 11215 | 2017-07-19 |
| 1063893089 | Namirembe Joan Kazibwe | Pediatrics | 539, 85th Street, Apt 3f, Brooklyn, NY 11209 | 2015-06-16 |
| 1114339322 | Michelle Quan | Pediatrics | 388 Bridge St, Apt 11b, Brooklyn, NY 11201-5210 | 2014-05-21 |
| 1215347026 | Babina K Nayak | Pediatrics | 435 Avalon Gardens Dr Apt 435, Nanuet, NY 10954-7433 | 2014-05-01 |
| 1952728883 | Thomas Hays | Pediatrics | 41 Hausman St, Brooklyn, NY 11222 | 2014-03-28 |
| 1437597614 | Umesh Paudel | Pediatrics | 100 Woods Rd Pmb 605, Valhalla, NY 10595 | 2013-06-10 |
| 1144668484 | Irina Kaminyar | Pediatrics | 24023 68th Ave, Douglaston, NY 11362-1928 | 2013-06-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.