Healthcare Provider Details

I. General information

NPI: 1821359670
Provider Name (Legal Business Name): MANDEL-WILENTZ DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NORTHERN BLVD
GREENVALE NY
11548-1346
US

IV. Provider business mailing address

45 NORTHERN BLVD
GREENVALE NY
11548-1346
US

V. Phone/Fax

Practice location:
  • Phone: 516-506-7546
  • Fax:
Mailing address:
  • Phone: 516-506-7546
  • Fax: 516-259-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number184691
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number184691
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number184691
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number184691
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number184691
License Number StateNY

VIII. Authorized Official

Name: DR. MITCHELL J MANDEL
Title or Position: PRESIDENT
Credential: MD
Phone: 516-506-7546