Healthcare Provider Details

I. General information

NPI: 1043254568
Provider Name (Legal Business Name): SCOTT MANDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DAKOTA DR
NEW HYDE PARK NY
11042-1135
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-455-2980
Mailing address:
  • Phone: 516-622-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number190301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: