Healthcare Provider Details

I. General information

NPI: 1952572224
Provider Name (Legal Business Name): RACHEL A MANDELBAUM NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL A BENSADIA NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 97TH ST
NEW YORK NY
10025-6450
US

IV. Provider business mailing address

275 W 238TH ST 3K
BRONX NY
10463-2308
US

V. Phone/Fax

Practice location:
  • Phone: 212-749-1820
  • Fax: 212-531-7514
Mailing address:
  • Phone: 718-543-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number565210
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberF304697
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberF420855
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: