Healthcare Provider Details

I. General information

NPI: 1780887950
Provider Name (Legal Business Name): MANDELL & BLAU, MD'S PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RIVERVIEW DR STE 104
DANBURY CT
06810-4211
US

IV. Provider business mailing address

PO BOX 230
GLASTONBURY CT
06033-0230
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-3002
  • Fax:
Mailing address:
  • Phone: 203-241-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRT FREDERICKSON
Title or Position: PRESIDENT
Credential: MD
Phone: 203-241-3470