Healthcare Provider Details

I. General information

NPI: 1194743559
Provider Name (Legal Business Name): LYNDA R MANDELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 PARK AVE APT 2D
NEW YORK NY
10075-0361
US

IV. Provider business mailing address

1020 PARK AVE STE 6B
NEW YORK NY
10028-0913
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-5400
  • Fax: 212-988-5404
Mailing address:
  • Phone: 212-988-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number25MA08059400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA08059400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number151612
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: