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General NPI Number Information
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NPI Number | 1306056973
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Entity Type | Individual
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Provider Name | RUSS B MANDOR DDS
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 CENTRAL PARK SOUTH SUITE #7C
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 212-755-3473
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Fax | 212-755-2055
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Provider Business Mailing Address
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Address Line | 114 E 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10021-4245
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Country | US
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Telephone | 212-737-5068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 033128
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License Number State | NY
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