Healthcare Provider Details

I. General information

NPI: 1215075908
Provider Name (Legal Business Name): CHAIM Y. MANDELBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MAIDEN LN SUITE 1206
NEW YORK NY
10038-4810
US

IV. Provider business mailing address

75 MAIDEN LN SUITE 1206
NEW YORK NY
10038-4810
US

V. Phone/Fax

Practice location:
  • Phone: 212-995-6495
  • Fax: 212-844-6772
Mailing address:
  • Phone: 646-602-8030
  • Fax: 646-602-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number193523
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number193523
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number193523
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number193523
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number193523
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number193523
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number193523
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: