MEDICARE: DR. JASON G. MANDELL MD

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	208000000X	Pediatrics Physician	MD045139	DC
2	208000000X	Pediatrics Physician	309047	NY
3	363AM0700X	Medical Physician Assistant	309047	NY
4	2080P0202X	Pediatric Cardiology Physician	309047	NY

General Provider Information

NPI Number	:	1578975363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON G. MANDELL MD

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE BOX 631
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-6090
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-2916
Country	:	US
Telephone Number	:	585-275-6108
Fax Number	:

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

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	07/07/2023

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