Basic Information
| Provider Information | |||||||||
| NPI: | 1659318467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDELSON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2021 WINTON RD S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857846400 | ||||||||
| FaxNumber: | 5853412370 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146202733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853416779 | ||||||||
| FaxNumber: | 5853418305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/17/2007 | ||||||||
| NPIReactivationDate: | 08/08/2007 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 203492 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | 203492 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 208M00000X | 203492 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RG0300X | 203492 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01908718 | 05 | NY | MEDICAID | 10475707 | 01 | CAQH PROVIDER ID | OTHER | BM5684243 | 01 | NY | DEA REGISTRATION | OTHER |