Healthcare Provider Details

I. General information

NPI: 1669594537
Provider Name (Legal Business Name): STEWART MANDELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 MANETTO HILL RD
PLAINVIEW NY
11803
US

IV. Provider business mailing address

42 MANETTO HILL RD
PLAINVIEW NY
11803
US

V. Phone/Fax

Practice location:
  • Phone: 516-433-0040
  • Fax: 516-433-0091
Mailing address:
  • Phone: 516-433-0040
  • Fax: 516-433-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number036073
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: