Healthcare Provider Details

I. General information

NPI: 1285024034
Provider Name (Legal Business Name): KAUSHIK MANDAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY SOUTH NASSAU COMMUNITIES HOSPITAL
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

1 HEALTHY WAY SOUTH NASSAU COMMUNITIES HOSPITAL
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 877-768-8462
  • Fax:
Mailing address:
  • Phone: 877-768-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number284827
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number284827
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number284827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: