=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720421001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRINA MANDEL ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2013
-----------------------------------------------------
Last Update Date | 03/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340C RAMAPO VALLEY RD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07436-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-962-6200
-----------------------------------------------------
Fax | 973-962-0046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340C RAMAPO VALLEY RD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07436-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-962-6200
-----------------------------------------------------
Fax | 973-962-0046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00419100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------