Provider Demographics
NPI:1760476477
Name:MENDELSON, AVISHAI (MD)
Entity type:Individual
Prefix:DR
First Name:AVISHAI
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310754
Mailing Address - Street 2:DEPT 4101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-0754
Mailing Address - Country:US
Mailing Address - Phone:561-255-3131
Mailing Address - Fax:561-444-3823
Practice Address - Street 1:1094 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-622-6111
Practice Address - Fax:855-215-9930
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379747300Medicaid
28928Medicare ID - Type Unspecified
FL379747300Medicaid