Healthcare Provider Details

I. General information

NPI: 1700575784
Provider Name (Legal Business Name): KRISTINA MANDALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE FL 15
NEW YORK NY
10029-7491
US

IV. Provider business mailing address

1901 1ST AVE FL 15
NEW YORK NY
10029-7491
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6271
  • Fax:
Mailing address:
  • Phone: 212-423-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number346291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: