Healthcare Provider Details

I. General information

NPI: 1932273612
Provider Name (Legal Business Name): JOSEPH MANDELBAUM, M.D. AND CRAIG R. SMOLOW, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARCUS AVE ST N204
NEW HYDE PARK NY
11042-1011
US

IV. Provider business mailing address

2001 MARCUS AVE ST N204
NEW HYDE PARK NY
11042-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-437-7202
  • Fax: 516-437-7602
Mailing address:
  • Phone: 516-437-7202
  • Fax: 516-437-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number080880
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number139589
License Number StateNY

VIII. Authorized Official

Name: MRS. VERED DEKEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-437-7202