Healthcare Provider Details

I. General information

NPI: 1285636175
Provider Name (Legal Business Name): BARBARA C MANDELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 BROADWAY 2ND FLOOR
HEWLETT NY
11557-1432
US

IV. Provider business mailing address

1490 BROADWAY 2ND FLOOR
HEWLETT NY
11557-1432
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-2900
  • Fax: 516-569-3442
Mailing address:
  • Phone: 516-569-2900
  • Fax: 516-569-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number126020-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: