Healthcare Provider Details

I. General information

NPI: 1336479880
Provider Name (Legal Business Name): MOLLIE MALKA MANDEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 76TH AVE
FOREST HILLS NY
11375-6466
US

IV. Provider business mailing address

115 10 QUEENS BOULVARD
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 347-563-1588
  • Fax: 718-544-0972
Mailing address:
  • Phone: 347-563-1588
  • Fax: 718-544-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number335037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: