Healthcare Provider Details

I. General information

NPI: 1316421043
Provider Name (Legal Business Name): YONATAN Y MANDELBAUM PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HARWOOD CT STE 512
SCARSDALE NY
10583-4120
US

IV. Provider business mailing address

3265 JOHNSON AVE STE 100
BRONX NY
10463-3539
US

V. Phone/Fax

Practice location:
  • Phone: 347-719-3078
  • Fax:
Mailing address:
  • Phone: 347-719-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00599400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023010
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: