Most Relevant Information
Provider Data
| NPI Number: | 1003597469 |
| Provider Name: | SAM TARIK MENDOUNE NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2200X |
| Specialty: | Nurse Practitioner |
| License Number: | F311288 |
Most Important Dates
| Enumeration Date: | 07/28/2023 |
| Last Updated: | 09/18/2023 |
Provider Practice Location
101 NICOLLS RD
STONY BROOK
NY
117940001
Practice Location Phone/Fax
| Phone: | 6313351657 |
| Fax: |
Provider Mailing Location
50 MARC DR
RIDGE
NY
119612139
Provider Mailing Phone/Fax
| Phone: | 6313351657 |
| Fax: |