Healthcare Provider Details

I. General information

NPI: 1710080726
Provider Name (Legal Business Name): MARK A. MANDEL, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MARIE CRES
COMMACK NY
11725-5221
US

IV. Provider business mailing address

66 MARIE CRES
COMMACK NY
11725-5221
US

V. Phone/Fax

Practice location:
  • Phone: 631-543-4242
  • Fax:
Mailing address:
  • Phone: 631-543-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX2058
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1016
License Number StateNY

VIII. Authorized Official

Name: DR. MARK ALEX MANDEL
Title or Position: CHIROPRACTOR/ ACUPUNCTURIST
Credential: D.C., L.AC.
Phone: 631-543-4242