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General NPI Number Information
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NPI Number | 1467624296
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Entity Type | Organization
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Legal Business Name | RICHARD MANDELBAUM MD PC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 164 CLYMER ST
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City | BROOKLYN
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State | NY
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Zip | 11211-7104
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Country | US
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Telephone | 718-384-6365
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Fax | 206-202-2774
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Provider Business Mailing Address
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Address Line | 164 CLYMER ST
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City | BROOKLYN
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State | NY
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Zip | 11211-7104
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Country | US
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Telephone | 718-384-6365
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Fax | 206-202-2774
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD I MANDELBAUM
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Credential | MD
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Telephone | 718-384-6365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 206316
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License Number State | NY
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