MEDICARE: DR. ARNOLD MANDELSTAM M.D.

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	2084P0800X	Psychiatry Physician	149158	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063472710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD MANDELSTAM M.D.

Provider Business Mailing Address
First Line	:	8044 190TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11423-1039
Country	:	US
Telephone Number	:	718-479-6699
Fax Number	:	718-776-6551

Provider Business Practice Location Address
First Line	:	80-44 190 ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11423-1309
Country	:	US
Telephone Number	:	718-479-6699
Fax Number	:	718-776-6551

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

Provider Enumeration Date	:	03/26/2006
Last Update Date	:	10/15/2010

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