Healthcare Provider Details

I. General information

NPI: 1467693697
Provider Name (Legal Business Name): MANDEL MEDICAL CONSULTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WEST 12TH STREET ST.VINCENT'S HOSPITAL MANHATTAN
NEW YORK NY
10011
US

IV. Provider business mailing address

33 CROFTS LN
STAMFORD CT
06903-3338
US

V. Phone/Fax

Practice location:
  • Phone: 914-740-3602
  • Fax:
Mailing address:
  • Phone: 914-740-3602
  • Fax: 914-654-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number161321
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL MANDEL
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 914-740-3602