Healthcare Provider Details

I. General information

NPI: 1225688237
Provider Name (Legal Business Name): WEST ORANGE ENDOCRINOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

10325 BIRCH TREE LN
WINDERMERE FL
34786-8021
US

V. Phone/Fax

Practice location:
  • Phone: 407-480-4830
  • Fax:
Mailing address:
  • Phone: 407-616-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE MANDRY
Title or Position: PRESIDENT
Credential: MD
Phone: 407-616-6094