MEDICARE: JILL MANDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	046727	NY

General Provider Information

NPI Number	:	1023614013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MANDEL

Provider Business Mailing Address
First Line	:	1636 MONTAUK HWY
Second Line	:
City	:	MASTIC
State	:	NY
Zip	:	11950-3016
Country	:	US
Telephone Number	:	631-399-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 MONTAUK HWY
Second Line	:
City	:	MASTIC
State	:	NY
Zip	:	11950-3016
Country	:	US
Telephone Number	:	631-399-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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Directions to “ JILL MANDEL ” Practice Location

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